Chest Infections |

An Uncommon Cause of Adult Respiratory Distress Syndrome FREE TO VIEW

Theresa Case, DO; Mehdi Khosravi, MD
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University of Kentucky, Lexington, KY

Chest. 2014;146(4_MeetingAbstracts):170A. doi:10.1378/chest.1993131
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SESSION TITLE: Infectious Disease Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Coronavirus HKU1 was identified in 2005. The Coronaviruses are positive-stranded RNA viruses and traditionally associated with mild upper respiratory tract infections. Chronic underlying disease, immunosuppression and old age increase the risk of severe illness and even death (1). The first described fatal cases were among elderly patients with major underlying respiratory and cardiovascular diseases (2).

CASE PRESENTATION: A 60 year old male presented with a two day history of “feeling unwell” and progressive shortness of breath. He has a medical history of hyperlipidemia, bronchiectasis, chronic obstructive pulmonary disease and chronic respiratory failure on 2L/minute oxygen by nasal cannula (NC) at baseline. At the time of presentation, his oxygen saturation was reported to be in the 30’s. He was immediately intubated for acute on chronic respiratory failure, en route to emergency room. An endotracheal aspirate PCR on day of admission was positive for Coronavirus HKU1. A bronchoscopy was performed the next day. All bacterial, fungal and viral cultures from the bronchoscopy were negative. The patient’s chest x-ray at presentation was compatible with Acute Respiratory Distress Syndrome (ARDS). His CVP was 13 cmH2O. His PaO2/FiO2 ratio was < 200, consistent with moderate ARDS. Supportive ventilator care with low tidal volume strategy and permissive hypercapnia was used. He required high FiO2 (80-100%) and positive end expiratory pressure (10-12 cmH2O) to maintain adequate oxygenation. A CT Chest was performed which showed diffuse ground glass opacities along with bronchiectasis and right upper lobe thin walled cavitary lesions. It was unknown whether the cavitary lesions were new or old as no prior CT scans were available for comparison. He was successfully extubated after 11 days and discharged to a rehabilitation facility after two weeks on 2.5 L/min oxygen by NC.

DISCUSSION: Coronaviruses, such as Coronavirus HKU1, Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV), have notably been found as new emerging pathogens that cause ARDS. These can be associated with extremely high mortality rates. There are currently no known antiviral treatments or vaccines for Coronavirus infection (3). Clinical management consists of supportive and palliative care.

CONCLUSIONS: We reported the first case of ARDS likely secondary to Coronavirus HKU1 infection in Kentucky. Coronaviruses should be considered a possible culprit of ARDS. At this point as no antiviral or vaccine is available, treatment is purely supportive. Other infectious causes of ARDS should be excluded.

Reference #1: Thomas Jartti, et al. New respiratory viral infections. Pulmonary Medicine. 2012; 18:271-278.

Reference #2: Krzysztof Pyrc, et al. The Novel Human Coronaviruses NL63 and HKU1. Journal of Virology. 2007; 3051-3057.

Reference #3: Rachael L. Graham, et al. A Decade After SARS: strategies for controlling emerging coronaviruses. Nature. 2013: 11: 836-848.

DISCLOSURE: The following authors have nothing to disclose: Theresa Case, Mehdi Khosravi

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