SHM Converge Scientific Abstract ePoster Gallery-A Tale of Two Pes: Adenovirus-Associated Pulmonary Emboli

Pdf Summary

This document presents two cases of pulmonary embolism (PE) occurring in patients with adenovirus infection, highlighting a possible but uncommon association between adenovirus and thrombotic events.

<strong>Case 1</strong> involved a 38-year-old woman with cough, fever, tachycardia, and mild hypoxemia. Initial chest X-ray showed bilateral airspace opacities, and a respiratory viral panel was positive for adenovirus. Despite supportive care, she remained tachycardic and hypoxic, prompting D-dimer testing and CT pulmonary angiography, which revealed a segmental PE. Transthoracic echocardiogram showed no right heart strain, and she was treated with apixaban and discharged home.

<strong>Case 2</strong> involved a 44-year-old woman with dyspnea, tachycardia, and significant oxygen requirement. Initial evaluation showed normal CBC and troponin, elevated D-dimer, and a CT-PA that was limited and did not show PE. COVID-19, influenza, and bacterial testing were negative, and adenovirus was later confirmed on repeat viral testing. Because her hypoxia persisted despite antibiotics, bronchodilators, and steroids, repeat CT-PA identified segmental and subsegmental PE. Again, there was no right heart strain, and she improved on apixaban.

The discussion notes that adenovirus has been linked in rare case reports to thrombotic events, and adenovirus-based vaccines have also been associated with venous thromboembolism, often through vaccine-induced thrombotic thrombocytopenic purpura (VITT). A proposed mechanism is activation of hemostatic pathways by adenovirus.

<strong>Key conclusion:</strong> clinicians should consider PE in patients with adenovirus pneumonia who have persistent hypoxemia or fail to improve as expected.

Asset Subtitle

Matthew DiFrancesco

Meta Tag

Author List Matthew DiFrancesco, Sarah Onorato

Category Clinical Vignettes

Concept Adenovirus Pneumonia

Concept Pulmonary Embolism

Concept Hypoxemia

Concept CT Pulmonary Angiography

Concept Thrombotic Event

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Matthew DiFrancesco

Track Adult

Keywords

adenovirus

pulmonary embolism

thrombotic events

hypoxemia

dyspnea

segmental PE

CT pulmonary angiography

D-dimer

apixaban

venous thromboembolism

Adenovirus Pneumonia

Pulmonary Embolism

Hypoxemia

CT Pulmonary Angiography

Thrombotic Event