Soni Parita, Rai Anand, Aggarwal Nidhi, Kamholz Stephan, Yoon Taek, Kupfer Yizhak
Maimonides Medical Center, Brooklyn, NY, USA.
J Investig Med High Impact Case Rep. 2017 Sep 5;5(3):2324709617728526. doi: 10.1177/2324709617728526. eCollection 2017 Jul-Sep.
A 22-year-old Asian woman presented with respiratory distress, cough, and wheezing for 1 week. Prior history included asthma and Turner syndrome. On presentation to the emergency department, the patient was hypotensive, tachycardic, tachypneic, with an oxyhemoglobin saturation in the mid 80% range while breathing ambient air. Chest radiograph revealed pulmonary vascular congestion and a left lower lobe infiltrate. Endotracheal intubation, mechanical ventilation, and vasopressors were initiated. Empiric therapy for community-acquired pneumonia was administered utilizing broad-spectrum intravenous antibiotics. Routine sputum culture was negative for pathogens. Nasopharyngeal swab submitted for multiplex amplified nucleic acid testing yielded enterovirus-human rhinovirus (EV-HRV). Thus, the diagnosis of EV-HRV pneumonia complicated by acute respiratory distress syndrome (ARDS) was established. Multiple attempts to wean from the ventilator were unsuccessful, and a tracheostomy was performed. This report highlights EV-HRV as a cause of severe ARDS and prolonged respiratory failure in adults.
一名22岁的亚洲女性因呼吸窘迫、咳嗽和喘息1周前来就诊。既往病史包括哮喘和特纳综合征。就诊于急诊科时，患者血压降低、心动过速、呼吸急促，在呼吸环境空气时氧合血红蛋白饱和度在80%左右。胸部X线片显示肺血管充血和左下叶浸润。遂开始进行气管插管、机械通气和使用血管加压药。采用广谱静脉抗生素对社区获得性肺炎进行经验性治疗。常规痰培养未发现病原体。送检的鼻咽拭子进行多重扩增核酸检测，结果显示为肠道病毒-人鼻病毒（EV-HRV）。因此，确诊为EV-HRV肺炎并发急性呼吸窘迫综合征（ARDS）。多次尝试撤机均未成功，遂行气管切开术。本报告强调了EV-HRV是成人严重ARDS和长期呼吸衰竭的一个病因。
