Takahashi Ikuko, Takahashi Tsutomu, Tsuchida Satoko, Mikami Tamaki, Saito Hiroyuki, Hatazawa Chiaki, Takada Goro
Department of Pediatrics, Akita University School of Medicine, Hondo 1-1-1, Akita-shi, Akita 010-8543, Japan.
Tohoku J Exp Med. 2006 May;209(1):69-73. doi: 10.1620/tjem.209.69.
Adenovirus pneumonia is uncommon but its severe infection has a mortality as high as 10%, and survivors may have residual airway damages, manifested by bronchiectasis, bronchiolitis obliterans, or pulmonary fibrosis. We report a case of adenovirus pneumonia demonstrating fatal respiratory distress. Adenovirus was isolated from pharyngeal specimens using cell culture and typed as serotype 3 by a combination of polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis. The patient characteristically showed hypercytokinemia, characterized by increased levels of lactate dehydrogenase, ferritin, and several cytokines including interferon-gamma and interleukin-6. We treated the patient with pulse methylprednisolne therapy (25 mg/kg/day, for 3 days), resulting in the rapid amelioration of respiratory distress. This is the first report describing the treatment of pulse methylprednisolone therapy in fatal adenovirus pneumonia. During the clinical course, serum Krebs von den Lungen-6 (KL-6), which is a marker for the activity of diffuse interstitial lung disease, was elevated, suggesting that serum KL-6 could be available as a marker of pulmonary prognosis in viral pneumonia.
腺病毒肺炎并不常见，但其严重感染的死亡率高达10%，幸存者可能会有气道残留损伤，表现为支气管扩张、闭塞性细支气管炎或肺纤维化。我们报告一例腺病毒肺炎导致致命性呼吸窘迫的病例。通过细胞培养从咽部分泌物中分离出腺病毒，并通过聚合酶链反应（PCR）和限制性片段长度多态性分析相结合的方法将其鉴定为3型血清型。该患者典型地表现为高细胞因子血症，其特征是乳酸脱氢酶、铁蛋白以及包括干扰素-γ和白细胞介素-6在内的多种细胞因子水平升高。我们用脉冲式甲泼尼龙治疗该患者（25mg/kg/天，共3天），结果呼吸窘迫迅速改善。这是第一份描述脉冲式甲泼尼龙治疗致命性腺病毒肺炎的报告。在临床过程中，作为弥漫性间质性肺疾病活动标志物的血清克雷布斯-冯-登-卢根-6（KL-6）升高，提示血清KL-6可作为病毒性肺炎肺部预后的标志物。
