Herpes Simplex Virus Pneumonia After Cardiac Surgery: Report of a Case

Abstract

A rare case of a 61-year-old man who developed herpes simplex virus (HSV) pneumonia after cardiac surgery is presented. He was immunocompetent before the operation and had no history of a mucocutaneous herpesvirus infection. This potentially fatal complication was successfully managed with acyclovir treatment after establishing the diagnosis with bronchoalveolar lavage. A depression of the patient's cell-mediated immunity after cardiopulmonary bypass may have been a causative factor. An unusual type of pneumonia such the HSV pneumonia seen in the present case should therefore be considered in patients with severe hypoxemia accompanied with unexplained pulmonary infiltrates after cardiac surgery using cardiopulmonary bypass which does not improve with conventional treatment.

Early inhibition of nitric oxide production increases HSV‐1 intranasal infection

“…In particular, several reports associate development of pneumonia in the above mentioned groups to HSV infection [Feldman and Stokes, 1987;Tuxen et al, 1987;Smyth et al, 1990;Schuller et al, 1993;Camazine et al, 1995;Cherr et al, 2000;Kitabayashi et al, 2000;Miyazato et al, 2001;Shimokawa et al, 2001;Taplitz and Jordan, 2002].…”

Herpes simplex virus pneumonia following mitral valve replacement

“…Recently, the polymerase chain reaction (PCR) has been utilized, providing a faster (i.e., approximately 24 h) diagnostic technique with high sensitivity and specifi city. 4,5,14 In the near future, PCR may become the gold standard used to diagnose HSV pneumonia.…”

“…1,2 However, clinical reports of HSV pneumonia after cardiac surgery are rare. [3][4][5] We report a patient who was diagnosed with HSV pneumonia and successfully treated with acyclovir during the postoperative period of mitral valve replacement (MVR).…”

Herpes simplex virus type-1 pneumonitis in immunocompetent young woman

“…Viral culture is useful but may not distinguish a carrier from true infection in 1% to 5% of asymptomatic adults, whereas serology must reveal a 4-fold increase in titer from acute sera; otherwise, an antibody increase may be interpreted as equivocal, especially in recurrent infections. [1][2][3][4][5][6][7][8][9][10][11][12] In regard to transmission, HSV-1 is acquired through contact with oral secretions, gingivostomatitis in children, or recurrent labialis in older hosts. The organism is also involved in approximately 10% to 30% in herpes genitalis.…”

“…In contrast, HSV pneumonia, either type 1 or 2, is a rare occurrence and almost exclusively observed in immunocompromised hosts (eg, the elderly; bone marrow transplant recipients; and those with malnutrition, malignancy, burns, severe pulmonary disease, or human immunodeficiency virus infection). [1][2][3][4][5][6][7][8][9][10][11][12] HSV is a widespread pathogen isolated from nearly all visceral and mucocutaneous sites, recognized mostly in immunocompromised patients. HSV pneumonia is rare and usually manifests as an acute respiratory distress syndrome.…”