Sumer Johannes, Waldeck Frederike, Fischer Nadja, Appenzeller Christina, Koster Markus, Früh Martin, Albrich Werner C
Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
Division of Pathology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
Pneumonia (Nathan). 2021 Jan 25;13(1):1. doi: 10.1186/s41479-020-00079-y.
Herpes simplex virus (HSV) is commonly associated with oro-facial and genital manifestations. It rarely causes encephalitis and even less commonly, in heavily immunosuppressed patients, visceral disease or bronchopneumonitis. We present a case of cytologically-proven, PCR-positive HSV-1 tracheobronchitis and pneumonitis in a patient with less severe immunocompromise.
A 64 year old white man with steroid-induced diabetes mellitus and progressive small-cell bronchial carcinoma despite chemo- and immunotherapy with two checkpoint inhibitors presented with symptoms of lower respiratory tract infection. Community-acquired pneumonia was suspected and empirical broad-spectrum antibacterial treatment was initiated. Chest CT-scan revealed ground-glass opacities and tree-in bud lesions. Cytology of BAL showed extensive cytopathic effects typically caused by infection with herpes virus and PCR confirmation of HSV-1. Acute phase HSV serology was positive for IgG and borderline for IgM. The patient deteriorated clinically due to tumor progress and infection despite high-dose acyclovir therapy and died 2 weeks after admission.
We report an unusual case of fatal HSV-1 pneumonitis due to reactivation in a patient with lung cancer, steroid-induced diabetes and treatment with two checkpoint inhibitors. In immunosuppressed patients with non-improving pneumonia invasive diagnostic procedures are warranted including cytology and molecular diagnostics.
单纯疱疹病毒（HSV）通常与口腔面部和生殖器表现相关。它很少引起脑炎，在重度免疫抑制患者中引起内脏疾病或支气管肺炎的情况甚至更少见。我们报告一例免疫抑制程度较轻的患者经细胞学证实、PCR检测呈阳性的HSV-1气管支气管炎和肺炎病例。
一名64岁白人男性，患有类固醇诱导的糖尿病，尽管接受了两种检查点抑制剂的化疗和免疫治疗，但仍患有进展性小细胞支气管癌，出现下呼吸道感染症状。怀疑为社区获得性肺炎并开始经验性广谱抗菌治疗。胸部CT扫描显示磨玻璃影和树芽征。支气管肺泡灌洗（BAL）细胞学检查显示广泛的细胞病变效应，通常由疱疹病毒感染引起，PCR证实为HSV-1。急性期HSV血清学检测IgG呈阳性，IgM临界值。尽管给予高剂量阿昔洛韦治疗，但患者因肿瘤进展和感染临床病情恶化，入院2周后死亡。
我们报告了一例因肺癌、类固醇诱导的糖尿病和接受两种检查点抑制剂治疗而复发导致致命性HSV-1肺炎的罕见病例。对于免疫抑制且肺炎病情无改善的患者，有必要进行包括细胞学和分子诊断在内的侵入性诊断程序。
