799 SEVERE ADENOVIRUS 7 PNEUMONIA IN A COMPROMISED HOST: IMMUNOLOGICAL INTERVENTION & SUCCESSFUL OUTCOME

Abstract

Adenovirus pneumonia in immunologically compromised hosts is usually fatal. A 6 y.o. girl with partial combined immunodeficiency (CID) presented with failure to thrive,high fever,cyanosis & extensive bilateral pneumonia unresponsive to antibiotics. She was neutropenic,lymphopenic & hypogammaglobulinemic(IgG=110mg%) She developed abnormal LFT's & thrombocytopenia.Open lung biopsy was performed.Adenovirus 7 was isolated in 2 days.Histopathology revealed a severe interstitial necrotizing pneumonia with typical Adenovirus inclusions.Two units of fresh frozen plasma(FFP) failed to alter her course.She was given gammaglobulin(GG)(1.8cc per kg)IM.Within 48 hrs. she improved dramatically.By virus neutralization tests the GG contained a high titer (1:240) of Adenovirus 7 antibody(AB). No AB could be detected in either unit of FFP. Recovery coincided with a substantial rise in serum AB titer to Adenovirus 7. Her clinical condition has remained stable over 9 mos. She has received GG(0.7cc/kg) every 3 wks. Evidence of CID persists with poor lymphocyte responses to PHA, Con A, PWM,and in MLC, & no response to Adenovirus 7.Total T-cell E-rosettes have risen from 44% to 75%. That the administration of specific AB resulted in a successful outcome is strengthened by comparison with an almost identical situation in Arabian foals with CID. That the mechanism of recovery was due to AB neutralization or AB-dependent cell-mediated cytotoxicity (ADCC) remains to be determined.