Abstract
The diagnosis of viral pneumonia is often difficult because of its varied presentations. Regarding the serological diagnosis of viral infections, it is difficult to perform a viral DNA test in general medical facilities, especially in rural settings. Among viral pneumonia cases, herpes simplex virus (HSV) pneumonia can occur in immunocompromised hosts. However, when the clinical course of HSV pneumonia is acute, and the features of pneumonia are not distinct, the diagnosis can be challenging. We report the case of a 69-year-old man who visited the hospital with complaints of dyspnea and cough for two days. Although the patient had no fever and the urine was negative for Legionella antigen, we suspected Legionella pneumonia based on the clinical course, Gram stain of sputum, and CT findings. After undergoing treatment with antibiotics, his condition worsened, with dyspnea and an increase in the demand for oxygen at 5 L. The patient also had complications related to the heart and liver. The sputum culture was negative, and the HSV serum test revealed that HSV IgM level was elevated to 1.16 (reference value: ≤0.80) and IgG level at admission and at follow-up 21 days later was elevated to 28.1 and 60.0 respectively (reference value: ≤2.0); accordingly, the patient was diagnosed with HSV pneumonia. In cases of pneumonia with atypical courses, the coexistence of multiple diseases, and immunosuppression, HSV pneumonia should be included in the differential diagnosis. In rural settings, viral pneumonia should be investigated using antibodies against viruses due to the limited availability of other medical resources. When a patient is judged to be immunosuppressed in the treatment of pneumonia of unknown cause, it is important to consider the possibility of HSV infection and take prompt action. Furthermore, it is essential to consider the possibility of multi-organ failure secondary to HSV infection, which requires systemic management.
Highlights
The diagnosis of viral pneumonia is often difficult because of its varying presentations
It is necessary to distinguish it from atypical pneumonia, such as pneumonia caused by mycoplasma [3]
We present a case of herpes simplex virus (HSV) pneumonia in a patient with heart failure and hepatic failure
Summary
The diagnosis of viral pneumonia is often difficult because of its varying presentations. He had not been exposed to patients suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection His medical history included hypertension, type 2 diabetes, dyslipidemia, alcoholic cirrhosis, and heart failure, and his last medical follow-up had been a year ago. PT-INR: prothrombin time-international normalized ratio; APTT: activated partial thromboplastin time; eGFR: estimated glomerular filtration rate; CK: creatine kinase; CRP: C-reactive protein; Ig: immunoglobulin; HCV: hepatitis C virus; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; HBs: hepatitis B surface; EBV VCA: Epstein-Barr virus capsid antigen; EBNA: Epstein-Barr virus nuclear antigen His chest CT showed bilateral pleural effusion and pan-lobular infiltration shadows (Figure 3). As the patient’s symptoms did not exacerbate and the risk of exacerbation of liver cirrhosis and renal failure was considered, we spared the usage of antiviral drugs for the exacerbation; 14 days later, HSV IgG level was elevated to >60 (reference value: ≤2.0). Continued nutritional therapy and rehabilitation improved his condition, and he was discharged home independently
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