Pulse Methylprednisolone Therapy in Type 3 Adenovirus Pneumonia with Hypercytokinemia

Abstract

Adenovirus pneumonia is uncommon but its severe infection has a mortality as high as 10%, and survivors may have residual airway damages, manifested by bronchiectasis, bronchiolitis obliterans, or pulmonary fibrosis. We report a case of adenovirus pneumonia demonstrating fatal respiratory distress. Adenovirus was isolated from pharyngeal specimens using cell culture and typed as serotype 3 by a combination of polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis. The patient characteristically showed hypercytokinemia, characterized by increased levels of lactate dehydrogenase, ferritin, and several cytokines including interferon-γ and interleukin-6. We treated the patient with pulse methylprednisolne therapy (25 mg/kg/day, for 3 days), resulting in the rapid amelioration of respiratory distress. This is the first report describing the treatment of pulse methylprednisolone therapy in fatal adenovirus pneumonia. During the clinical course, serum Krebs von den Lungen-6 (KL-6), which is a marker for the activity of diffuse interstitial lung disease, was elevated, suggesting that serum KL-6 could be available as a marker of pulmonary prognosis in viral pneumonia. type 3 adenovirus; pneumonia; pulse methylprednisolone therapy;

Epidemiology, clinical presentation and respiratory sequelae of adenovirus pneumonia in children in Kuala Lumpur, Malaysia

“…Takahashi et al reported that use of pulse methylprednisolone (25mg/kg/day) for 3 days, in a case of severe HAdV pneumonia (type 3) with hypercytokinemia i.e raised lactate dehydrogenase, ferritin, interferon-gamma and interleukin-6, resulted in relief of respiratory distress. [ 29 ] He also suggested that serum Krebs von den Lungen-6 (Kl-6) could be used as a marker of future lung disease. Cidofivir is occasionally used in immunocompromised children with severe HAdV.…”

Severe Community-Acquired Pneumonia Caused by Human Adenovirus in Immunocompetent Adults: A Multicenter Case Series

“…The effect of corticosteroids on severe HAdV CAP is still uncertain, although there have been a few case reports. One case of a fatal HAdV-3 pneumonia with hypercytokinemia, “pulse” methylprednisolone treatment resulted in the rapid amelioration of the patient’s respiratory distress [29]. In a study focused on severe CAP caused by HAdV-55, 10 out of 18 patients received corticosteroids and total mortality was 5.9% [17].…”

Severe Adenovirus Infection Associated with Hemophagocytic Lymphohistiocytosis

“…There have been a limited number of case reports describing adenovirus pneumonia complicated with HLH [2,4,5,6]. In these reports, adenoviral pneumonia with HLH was successfully treated with IVIG and clarithromycin, dexamethasone and cyclosporine, or pulse methylprednisolone [2,4,6].…”

“…There have been a limited number of case reports describing adenovirus pneumonia complicated with HLH [2,4,5,6]. In these reports, adenoviral pneumonia with HLH was successfully treated with IVIG and clarithromycin, dexamethasone and cyclosporine, or pulse methylprednisolone [2,4,6]. Antiviral treatment with cidofovir or ribavirin in adenovirus infections is being increasingly used, especially in immunocompromised patients; however, the efficacy of these drugs is not established [7,8].…”