Severe community-acquired adenovirus pneumonia in an immunocompetent 44-year-old woman: a case report and review of the literature

Abstract

IntroductionThis case report describes a rare condition: community-acquired adenovirus pneumonia in an immunocompetent adult. The diagnosis was achieved by using a multiplex real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay and highlights the usefulness of these novel molecular diagnostic techniques in patients hospitalized with acute respiratory illness. We also performed a literature search for previously published cases and present a summary of the clinical, laboratory and radiological features of this condition.Case presentationA 44-year-old immunocompetent Caucasian woman was admitted to our hospital with an acute febrile respiratory illness associated with a rash. Her blood tests were non-specifically abnormal, and tests for bacterial pathogens were negative. Her condition rapidly deteriorated while she was in our hospital and required mechanical ventilation and inotropic support. A multiplex real-time RT-PCR assay performed on respiratory specimens to detect respiratory viruses was negative for influenza but positive for adenovirus DNA. The patient recovered on supportive treatment, and antibiotics were stopped after 5 days.ConclusionsCommunity-acquired adenovirus pneumonia in immunocompetent adult civilians presents as a non-specific acute febrile respiratory illness followed by the abrupt onset of respiratory failure, often requiring mechanical ventilation. Its laboratory and radiological features are typical of viral infections but also are non-specific. Novel multiplex real-time RT-PCR testing for respiratory viruses enabled us to rapidly make the diagnosis in this case. The new technology could be used more widely in patients with acute respiratory illness and has potential utility for rationalization of the use of antibiotics and improving infection control measures.

Serology Enhances Molecular Diagnosis of Respiratory Virus Infections Other than Influenza in Children and Adults Hospitalized with Community-Acquired Pneumonia

“…This suggests that RT-PCR alone may overestimate the true number of AdV infections etiologically linked with CAP. Nevertheless, it is important to recognize AdV infections because of their potential to cause severe, sometimes fatal pneumonia (27).…”

Acute respiratory distress syndrome in adenovirus type 4 pneumonia: A case report

“…According to literature, most frequent symptoms associated with severe adenoviral pneumonia are prolonged fever, respiratory compromise with hypoxia and rapid deterioration of clinical condition, requiring intubation and ventilation [20,21]; bilateral interstitial infiltrates are the most common radiological findings [1,4,7]. Lymphopenia, thrombocytopenia and elevated transaminases levels are frequently observed.…”

“…Human adenoviruses (HAdVs) are non enveloped, double stranded DNA viruses usually causing acute febrile and self-limiting respiratory infections in children [1,4]. Severe infections are usually observed in neonates [2] and immunocompromised adults, such as HIV-positive individuals or transplanted patients [3,5].…”

“…Severe infections are usually observed in neonates [2] and immunocompromised adults, such as HIV-positive individuals or transplanted patients [3,5]. However, few cases of adenovirus-associated community-acquired pneumonia with acute respiratory distress syndrome (ARDS) have been described in immunocompetent adults [1,6]. To date, more than 50 HAdV types have been identified and grouped in seven different species (A-G) [11].…”

“…In literature, various severe adenoviral pneumonia have been described [1,3,6,13,14,[19][20][21]. Common clinical manifestation (fever, respiratory impairment, ARDS that required respiratory support with extracorporeal membrane oxygenation) were reported.…”