SHM Converge Scientific Abstract ePoster Gallery-When Common Symptoms Mask a Rare Culprit: Herpes Simplex Virus Pneumonitis in Acute Respiratory Failure

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This case describes an 86-year-old woman with several weeks of progressive shortness of breath, productive cough, weight loss, and worsening hypoxemia despite home oxygen. Initial chest imaging showed bilateral multilobar infiltrates and CT scans revealed ground-glass opacities, bilateral lower-lobe consolidation, and nodular upper-lobe infiltrates concerning for malignancy or infection. Despite multiple courses of broad-spectrum antibiotics and steroids, her respiratory status continued to decline.<br /><br />Because the presentation was nonspecific and nonresponsive to standard therapy, bronchoscopy with bronchoalveolar lavage and transbronchial biopsies was performed. Pathology showed chronic interstitial inflammation and atypical cells with viral cytopathic effect. Immunohistochemistry confirmed Herpes Simplex Virus pneumonitis with positivity for both HSV-1 and HSV-2. Cultures also identified bacterial and fungal co-infections, including Stenotrophomonas maltophilia, Granulicatella adiacens, and fungal elements, which complicated treatment.<br /><br />She was treated with valacyclovir, additional antibiotics guided by culture sensitivities, corticosteroids, antifungal therapy, and aggressive pulmonary hygiene. Her hypoxemia improved gradually, allowing weaning from high-flow nasal cannula to low-flow oxygen. Complications during hospitalization included hyponatremia and atrial fibrillation with rapid ventricular response, both managed medically.<br /><br />The case highlights the diagnostic challenge of HSV pneumonitis, a rare and often overlooked cause of respiratory failure, especially in elderly patients. It emphasizes that when pulmonary infiltrates do not improve with conventional treatment, clinicians should maintain a broad differential and pursue tissue diagnosis early. Prompt recognition of viral pneumonia and targeted therapy can be crucial for recovery, particularly when co-infections are present.

Asset Subtitle

Carlos J. Ramirez Matos

Meta Tag

Author List Adriana Morales Rivera, Carlos J. Ramirez Matos, Evander Boynton, Vimary Bermudez-Rosado

Category Clinical Vignettes

Concept Herpes Simplex Virus Pneumonitis

Concept Respiratory Failure

Concept Bronchoalveolar Lavage

Concept Tissue Diagnosis

Concept Non-resolving Bilateral Pulmonary Infiltrates

Distinguished Non-Finalist

Presenter Organization Palmetto General Hospital

Presenting Author Carlos J. Ramirez Matos

Track Adult

Keywords

Herpes Simplex Virus pneumonitis

HSV-1

HSV-2

hypoxemia

ground-glass opacities

bronchoalveolar lavage

transbronchial biopsy

valacyclovir

Stenotrophomonas maltophilia

fungal co-infection

Herpes Simplex Virus Pneumonitis

Respiratory Failure

Bronchoalveolar Lavage

Tissue Diagnosis

Non-resolving Bilateral Pulmonary Infiltrates