A Rare Case of Adenovirus Pneumonia Resulting in Severe ARDS in an Immunocompetent Adult

Abstract

SESSION TITLE: Student/Resident Case Report Poster - Critical Care IV SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Adenovirus is a common cause of respiratory tract infections in pediatric and adult patients and typically manifests as a variant of the common cold. Severe illness secondary to adenovirus infection in immunocompetent adults is rare. We present a case of severe acute respiratory distress syndrome (ARDS) secondary to adenovirus pneumonia in an immunocompetent adult that progressed to shock, multisystem organ failure, and death. CASE PRESENTATION: A 66-year-old male with chronic obstructive pulmonary disease was admitted with several days of dyspnea. On admission, he was febrile to 39.4oC, tachycardic to 140 beats/minute, tachypneic to 44 breaths/minute, and hypoxemic with an oxygen saturation of 86% on ambient air. Chest radiography demonstrated bilateral opacities concerning for multi-focal pneumonia. He was empirically treated with vancomycin, piperacillin-tazobactam, and oseltamivir, and initiated on non-invasive positive pressure ventilation for respiratory support. Because of a rapidly increasing oxygen requirement, he was intubated and mechanically ventilated within 24 hours of admission. A respiratory viral panel was positive for adenovirus type B/E, and culture of a bronchoalveolar lavage specimen was negative for bacteria. Quantitative PCR of the serum showed a viral load greater than 560,000 copies/ml. He experienced progressive ARDS and was managed with lung protective ventilation, deep sedation, paralysis, prone positioning, and inhaled epoprostenol. Based on a rapidly deteriorating clinical course, cidofovir was administered. Despite this, he developed progressive distributive shock requiring vasopressor support and acute kidney injury requiring continuous renal replacement therapy. On hospital day 11, he experienced a cardiac arrest and subsequently expired after withdrawal of aggressive care. DISCUSSION: Severe adenovirus infection is predominantly seen in immunocompromised hosts, such as neonates and transplant recipients. Epidemics of adenovirus in military recruits have been reported and temporarily prompted vaccination. The CDC reported an outbreak of adenovirus serotype 14 in three states in 2007 affecting 140 patients; 24 required ICU care, and 9 died. Although used to treat adenovirus in transplant recipients, the efficacy of cidofovir in immunocompetent adults is unknown. CONCLUSIONS: Adenovirus is a rare cause of pneumonia in immunocompetent adults but can be associated with life-threatening complications, including ARDS, multisystem organ failure, and death. Appreciation of the potential virulence of the pathogen, heightened vigilance in its diagnosis, and better therapeutics are essential to managing patients, particularly those requiring critical care. Reference #1: Dingle JH, Langmuir AD. Epidemiology of acute, respiratory disease in military recruits. Am Rev Respir Dis. 1968;97(6) Reference #2: CDC: MMWR: Acute Respiratory Disease Associated with Adenovirus Serotype 14 --- Four States. November 16, 2007 / 56(45); 1181-1184 DISCLOSURE: The following authors have nothing to disclose: Shaeesta Khan, Steven Keller, Nithya Sritharan, Brad Butcher No Product/Research Disclosure Information