Lung Pathology: Fellow Case Report Poster - Lung Pathology |

A Fatal Case of ARDS From Adenovirus Pneumonia FREE TO VIEW

Kathleen Doo, MD; Samantha D'Annunzio, MD; John Paulsen, MD; Amy Rapkiewicz, MD; Omar Azar, MD; John Munger, MD
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New York University, New York, NY

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

Chest. 2016;150(4_S):779A. doi:10.1016/j.chest.2016.08.875
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SESSION TITLE: Fellow Case Report Poster - Lung Pathology

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Adenoviruses are a family of viruses commonly associated with upper respiratory tract syndromes in young children. Most adenoviral diseases are self-limiting. In immunocompromised hosts, adenoviruses cause a wide range of clinical syndromes, including pneumonia, hemorrhagic cystitis/nephritis, colitis, hepatitis, and encephalitis.

CASE PRESENTATION: A 36-year-old woman with a history of IV drug use, AIDS (CD4+ 1 cell/mm3, viral load 101,000 copies/mL, non-compliant with HAART), and HCV presented with one month of fatigue and productive cough and two weeks of fevers, night sweats, and shortness of breath. Initial laboratory evaluation revealed WBC 3 x 109/L and LDH 668 U/L (institutional ULN 225 U/L). She was started on broad-spectrum antibiotics, including PCP treatment and steroids. Bronchoscopy with BAL was non-diagnostic. Blood, fungal, and AFB cultures, as well as Aspergillus, Cryptococcus, Histoplasma, and Legionella antigens were negative. PCP cytology and influenza PCR were negative. Her condition worsened and she was intubated for hypoxia and septic shock. Repeat CT showed progressive multifocal pneumonia with peripherally distributed infiltrates. She developed severe ARDS and died. Autopsy revealed fulminant adenovirus infection in both lungs.

DISCUSSION: Adenoviral pneumonia on CT typically appears as poorly defined nodules, peribronchial ground glass opacities or consolidation. Pathology shows epithelial cell congestion, necrosis, neutrophilic exudate and diffuse alveolar damage. In the pre-HAART era, asymptomatic adenoviruria was reported to be present in 20% of HIV/AIDS patients; disseminated infection often resulted in death. Although the GI tract is the most common site, pulmonary infection is associated with a mortality rate near 60%.

CONCLUSIONS: Adenoviral infections cause morbidity and mortality in immunocompromised persons and should be included in the differential diagnosis of pneumonia in persons with HIV/AIDS.

Reference #1: Kim, EA et al. Viral Pneumonias in Adults: Radiologic and Pathologic Findings. RadioGraphics. 2002; 22(suppl):S137-S149.

Reference #2: Adeyemi, OA et al. Fatal Adenovirus Pneumonia in a Person with AIDS and Burkitt Lymphoma: A Case Report and Review of the Literature. AIDS Reader. 2008; 18:196-198, 201-202, 206-207.

DISCLOSURE: The following authors have nothing to disclose: Kathleen Doo, Samantha D'Annunzio, John Paulsen, Amy Rapkiewicz, Omar Azar, John Munger

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