Rhinovirus, When Is It More Than Just a Cold? Rhinovirus as a Cause of Organizing Pneumonia in Two Patients With Hematological Cancer

Abstract

Abstract Human rhinoviruses are pathogens that cause significant morbidity and economic strain from upper respiratory infections. Rhinovirus has also been associated with exacerbations of chronic lung disease. Less understood is the role of rhinovirus in organizing pneumonia (OP). Organizing pneumonia is a certain lung pattern of injury that occurs after injury to the pulmonary parenchyma, with infection being the most studied etiology. It typically presents with similar symptoms to pneumonia, and patients are often treated with antibiotics to lack of improvement. However, OP is more subacute in presentation, and the treatment, systemic glucocorticoids, differs from bacterial pneumonia. Recognition of rhinovirus as a significant pathogen in immunocompromised patients is important because it tends to cause more severe disease in this group. Here, we present a case series of 2 hematological malignancy patients with a long-standing rhinovirus infection and lung disease unresponsive to antibiotics, later found on biopsy to be OP. Both patients survived the infection, and both patients had documented rhinovirus shedding for greater than 9 months. Both patients had lymphoma and were being actively treated with a monoclonal antibody that targeted cluster of differentiation 20. Both patients reported fever and dyspnea. Both patients had multiple superimposed bacterial infections, with both patients eventually developing Pseudomonas aeruginosa pneumonia. In the immunocompromised, rhinovirus may cause morbidity through a primary infection, a secondary bacterial infection, or OP. Novel treatment strategies and increased awareness are needed not only for rhinovirus-induced OP but also for rhinovirus as an important pathogen in immunocompromised patients.