Chest Infections: Chest Infections II |

Severe Community-Acquired Pneumonia Caused by Adenovirus 7 in a Pregnant Woman: An Unusual Case Report FREE TO VIEW

Jiping Liao, MD; Guangfa Wang, MD; Zhe Jin, MD; Yuan Qian, PhD; Jie Deng, PhD; Qinwei Song, PhD
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Department of Pulmonary and Critical Care Medicine, Peking University First Hospital, Beijing, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A116. doi:10.1016/j.chest.2016.02.121
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SESSION TITLE: Chest Infections II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Adenovirus is not a common etiology of pneumonia in pregnant women.

CASE PRESENTATION: A 28-year-old pregnant woman at 26+4 weeks of gestation was presented with prolonged high grade fever for five days, accompanied by rigors, malaise, and cough with purulent sputum. Blood tests showed lymphocytopenia, and double increase of liver enzymes, and increased CRP. She got increasingly respiratory distress and received non-invasive ventilation despite of broad-spectrum antibiotics for 5 days. Chest ultrasound showed left-sided moderate free-flowing pleural effusion. Thoracentesis analysis showed exudative pleural effusion with lymphocyte predominated. A low-dose chest computed tomography with abdomen protection revealed massive left lung consolidation and patchy infiltrates in right middle and lower lobes (figure 1). After appropriate supportive care and obstetrical management, she was fully recovered and was discharged on day 18. PCR, nested PCR and gene sequencing of nasopharyngeal aspirates were finally positive for adenovirus type 7, which was confirmed by more than four-fold elevation of IgG titer of adenovirus type 7. On follow-up, she had a natural delivery at 39+2 weeks of gestation, the baby is so far healthy at regular follow-up by 17 month.

DISCUSSION: This is the first report of adenovirus 7 pneumonia occurred in previously healthy pregnant woman. Our patient had prolonged fever, cough and dyspnea, normal WBC with lymphopenia, bilateral lung infiltrates, and pleural exudates dominated by mononuclear cells. It was in accordance with the scenario of adenoviral pneumonia as previously reported [1]. There were no effective antiviral treatment to adenoviral pneumonia, for our patient, proper supportive care, such as oxygen therapy, non-invasive mechanical ventilation, defervesce and obstetric treatment lead to successful cure. Fortunately, there are neither adverse pregnant outcomes of our patient nor teratogenesis of her baby except transient threatened abortion. Previous studies showed pregnant women with viral pneumonia have a higher mortality rate, higher rates of both intubation and ICU admission than the general population.

CONCLUSIONS: In conclusion, this case of adenoviral pneumonia reminds physicians to be aware of etiologic diagnosis of pneumonia in pregnant women.

Reference #1: Sun B, He H, Wang Z, Qu J, Li X, Ban C, et al. Emergent severe acute respiratory distress syndrome caused by adenovirus type 55 in immunocompetent adults in 2013: a prospective observational study. Crit Care 2014,18:456.

DISCLOSURE: The following authors have nothing to disclose: Jiping Liao, Guangfa Wang, Zhe Jin, Yuan Qian, Jie Deng, Qinwei Song

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