Pneumomediastinum and Pneumothorax Associated with Herpes Simplex Virus (HSV) Pneumonia

Abstract

Patient: Male, 37Final Diagnosis: HSV pneumoniaSymptoms: Cough • fever • sobMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Unusual clinical courseBackground:Pneumonia is one of the most common causes of death from infectious disease in the United States (US). Although most cases of community-acquired pneumonia (CAP) are secondary to bacterial infection, up to one-third of cases are secondary to viral infection, most commonly due to rhinovirus and influenza virus. Pneumonia due to herpes simplex virus (HSV) is rare, and there is limited knowledge of the pathogenesis and clinical complications. This report is of a fatal case of HSV pneumonia associated with bilateral pneumothorax and pneumomediastinum.Case Report:A 36-year-old homeless male Hispanic patient, who was a chronic smoker, with a history of intravenous drug abuse and a medical history of chronic hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, not on highly active antiretroviral therapy (HAART), was admitted to hospital as an emergency with a seven-day history of productive purulent cough. The patient was admitted to the medical intensive care unit (MICU) with a diagnosis of CAP, with intubation and mechanical ventilation. Broncho-alveolar lavage (BAL) was performed and was positive for HSV. The patient developed bilateral pneumothorax with pneumomediastinum, which was fatal, despite aggressive clinical management.Conclusions:Pneumonia due to HSV infection is uncommon but has a high mortality. Although HSV pneumonia has been described in immunocompromised patients, further studies are required to determine the pathogenesis, early detection, identification of patients who are at risk and to determine the most effective approaches to prophylaxis and treatment for HSV pneumonia.

Pneumothorax in Mechanically Ventilated Patients with COVID-19 Infection

“…Pneumothorax has been reported with many infections like Influenza [ 11 ], Herpes simplex virus [ 12 ], and Pneumocystis pneumonia [ 13 ]. Although acute respiratory distress syndrome (ARDS) is the primary cause of mortality in COVID-19 infection, early diagnosis and treatment of serious complications such as pneumothorax [ 14 , 15 ], pneumomediastinum [ 16 , 17 ], or pulmonary embolism [ 18 ] also carry utmost importance.…”

A case report of pneumomediastinum in a COVID‐19 patient treated with high‐flow nasal cannula and review of the literature: Is this a “spontaneous” complication?

“…Spontaneous pneumomediastinum is defined as air in the mediastinum without evident causes (eg, traumatic, iatrogenic, hollow organ perforation, gas‐producing infection surgery, or any other interventions) 8 . Numerous reports 24‐56 have demonstrated that several lung infections, mainly influenza, provoke pneumomediastinum. Radiological features are different in influenza pneumonia compared with COVID‐19 and pneumomediastinum is believed to be a much less frequent complication (or never occurs) in COVID‐19 pneumonia 31,32,35,37,57 .…”

A Rare Complication of Asthma: Retropharyngeal Emphysema, Subcutaneous Emphysema, and Pneumomediastinum

“…If an esophageal rupture is in the differential, a fluoroscopic esophagogram can be obtained, as was the case in our patient. If contrast is seen freely flowing through the esophagus without obstruction or diffusing out of the esophagus, rupture and obstruction are both much less likely [4][5][6].…”

“…The gas produced internally, during a pneumomediastinum, can track from the mediastinum to the subcutaneous tissues, usually of the neck and chest. This gas may also make its way into the retropharyngeal fascia, producing a rare clinical picture of retropharyngeal emphysema (RPE) [1][2][3][4][5].…”