Case Presentation:
A 19 year old obese African American male with past medical history of asthma presented to the emergency room with sudden onset of shortness of breath. He had cough with expectoration of greenish sputum for 1 week prior to presentation. Review of system was negative except for watery diarrhea of 2 days duration. He is a nonsmoker, nonalcoholic and didn’t have any risk factors for HIV. In the emergency room, he was febrile (102 F), tachypneic, tachycardic with a blood pressure of 144/60 mm Hg and saturating 94% on room air. Clinical exam was remarkable for mild pharyngeal and tonsillar erythema and decreased breath sound in the left lower lung field with bilateral scattered rhonchi. Laboratory investigations revealed pancytopenia, and normal comprehensive metabolic panel. Electrocardiogram revealed sinus tachycardia. Chest X Ray showed consolidation in left lower lobe. Arterial Blood gas revealed hypoxemia with mild respiratory alkalosis. Computerized Tomography Angiogram of Chest revealed bilateral airspace opacities and no evidence of pulmonary embolism. He was started on broad spectrum antibiotics. Over next 12 hours, patient developed worsening respiratory distress with desaturation and was transferred immediately to intensive care unit. Blood and Sputum Cultures drawn at the time of admission were negative. His respiratory viral panel showed adenovirus and serology showed high adenoviral titers. Urine antigens for Legionella and pneumococcus, Serology for mycoplasma, histoplasmosis and HIV were negative. His Lupus anticoagulant came positive with an abnormal DRVVT and prolonged activated Partial Thromboplastin time. Auto-antibody panel was negative. He showed remarkable improvement after a week of supportive treatment including non-invasive ventilation, pulmonary toilet and hydration. His pancytopenia resolved and lupus anticoagulant became weakly positive by the time of discharge. He was doing well on a 2 month follow up visit and his Lupus anticoagulant became negative.
Discussion:
Community-acquired adenoviral pneumonia in immunocompetent adults usually presents as a non-specific febrile respiratory illness and rarely progresses to respiratory failure requiring mechanical ventilation. Treatment of adenovirus generally includes supportive care and antiviral therapy with cidofovir is reserved for immunocompromised hosts.
Conclusions:
Severe adenovirus respiratory infections in immunosuppressed individuals have been well described but only few cases have been reported in immunocompetent adults. In the patient we reported there was no evidence of immunosuppression and he showed remarkable improvement with supportive treatment and did not require antiviral therapy. Association of antiphospholipid antibodies with infections have been observed previously with viruses particularly adenovirus. These tend to be transient and usually require no treatment other than treating the underlying infection.