Nam Kyung Hun, Kang Junho, Koh Younsuck
Dept. of Pulmonary and Critical Care Medicine, Asan Medical Center 43 Gil 88 Olympic Ro Songpa Ku Seoul 05505, Republic of Korea.
Respir Med Case Rep. 2021 May 27;33:101399. doi: 10.1016/j.rmcr.2021.101399. eCollection 2021.
Respiratory syncytial virus infection is gaining interest in the elderly due to its growing morbidity and mortality. We present a Case of respiratory syncytial virus infection presenting as diffuse alveolar hemorrhage that was highly responsive to systemic corticosteroid in an elderly patient.
An 82-year old man was admitted to the intensive care unit with worsening hypoxic respiratory failure. Chest radiograph showed non-homogeneous air space opacities. Bronchoalveolar lavage showed a finding of alveolar hemorrhage. The diagnosis of diffuse alveolar hemorrhage was made and high-dose systemic corticosteroid was given. However, concomitant respiratory syncytial virus infection was later confirmed. Therefore, ribavirin and human immunoglobulin were added. During the course of his treatment, the steroid was stopped and restarted. Interestingly, the clinical course was highly responsive to systemic corticosteroid.
It appears that diffuse alveolar hemorrhage in this patient may have been due to an immunological process caused by respiratory syncytial virus. Therefore, corticosteroid therapy was highly effective in improving the patient's hemoptysis and hypoxic respiratory failure. We suggest that further studies are required on the use of steroid in this subset of patients with respiratory syncytial virus lower respiratory tract infection.
由于呼吸道合胞病毒感染的发病率和死亡率不断上升，该感染在老年人中越来越受到关注。我们报告一例呼吸道合胞病毒感染病例，该病例表现为弥漫性肺泡出血，在一名老年患者中对全身使用皮质类固醇有高度反应。
一名82岁男性因进行性缺氧性呼吸衰竭入住重症监护病房。胸部X光片显示肺部有不均匀的实变影。支气管肺泡灌洗显示有肺泡出血。诊断为弥漫性肺泡出血，并给予高剂量全身皮质类固醇治疗。然而，后来证实同时存在呼吸道合胞病毒感染。因此，加用了利巴韦林和人免疫球蛋白。在治疗过程中，停用并重新开始使用类固醇。有趣的是，临床过程对全身皮质类固醇有高度反应。
该患者的弥漫性肺泡出血可能是由呼吸道合胞病毒引起的免疫过程所致。因此，皮质类固醇治疗在改善患者咯血和缺氧性呼吸衰竭方面非常有效。我们建议对这一亚组呼吸道合胞病毒下呼吸道感染患者使用类固醇进行进一步研究。
