Dimeas Ilias E, Skrimizeas Stratos, Dimeas George, Gerogianni Irini, Daniil Zoe
Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, University General Hospital of Larissa, Larissa, GRC.
Department of Internal Medicine, General Hospital of Karditsa, Karditsa, GRC.
Cureus. 2024 Dec 5;16(12):e75165. doi: 10.7759/cureus.75165. eCollection 2024 Dec.
Adenovirus is a common pathogen responsible for respiratory infections, including pneumonia, predominantly in pediatric populations but also in immunocompromised adults. This case report details an 18-year-old immunocompetent male presenting with severe lobar pneumonia and pleural effusion, initially suggesting a bacterial origin. Despite antibiotic treatment, the patient's symptoms persisted, prompting further investigation. The diagnostic approach included polymerase chain reaction testing on upper-airway specimens, pleural effusion, and bronchoalveolar lavage, which identified adenovirus as the causative agent. This diagnosis confirmed that adenoviral pneumonia could present with radiologic findings similar to bacterial infections, such as lobar consolidation and pleural effusion, which are typically considered suggestive of bacterial etiology. The successful identification of adenovirus from pleural effusion, previously reported in bronchoalveolar lavage or upper-airway specimens, is a novel aspect of this case, underscoring the importance of comprehensive diagnostic testing, especially in atypical or severe cases that fail to respond to empiric therapy. Antimicrobial therapy was continued to prevent secondary bacterial infections, but the primary treatment was supportive care. The patient showed significant clinical improvement and was discharged in stable condition after seven days, with no residual symptoms at follow-up. This case highlights the need for careful consideration of viral pathogens, particularly adenovirus, in the differential diagnosis of severe pneumonia, even in the presence of pleural effusion, to avoid unnecessary antibiotic escalation and guide appropriate management. Early viral identification and tailored treatment strategies are essential, particularly in cases that do not respond to conventional therapies. Furthermore, this case emphasizes the value of advanced diagnostic techniques in identifying less common pathogens and reducing the risks of unnecessary antibiotic use.
腺病毒是引起呼吸道感染的常见病原体，包括肺炎，主要发生在儿童群体中，但免疫功能低下的成年人也会感染。本病例报告详细介绍了一名18岁免疫功能正常的男性，他患有严重的大叶性肺炎和胸腔积液，最初提示为细菌感染。尽管进行了抗生素治疗，患者的症状仍持续存在，促使进一步检查。诊断方法包括对上呼吸道标本、胸腔积液和支气管肺泡灌洗进行聚合酶链反应检测，结果确定腺病毒为病原体。这一诊断证实，腺病毒性肺炎可能出现与细菌感染相似的影像学表现，如大叶实变和胸腔积液，而这些通常被认为提示细菌病因。从胸腔积液中成功鉴定出腺病毒，此前曾在支气管肺泡灌洗或上呼吸道标本中报告过，这是该病例的一个新特点，强调了全面诊断检测的重要性，尤其是在对经验性治疗无反应的非典型或严重病例中。继续使用抗菌疗法以预防继发性细菌感染，但主要治疗方法是支持性护理。患者临床症状明显改善，7天后病情稳定出院，随访时无残留症状。本病例强调，在严重肺炎的鉴别诊断中，即使存在胸腔积液，也需要仔细考虑病毒病原体，特别是腺病毒，以避免不必要的抗生素升级并指导适当的治疗。早期病毒鉴定和针对性的治疗策略至关重要，尤其是在对传统疗法无反应的病例中。此外，本病例强调了先进诊断技术在识别不太常见病原体和降低不必要使用抗生素风险方面的价值。
