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;
Background: Respiratory syncytial virus (RSV) bronchiolitis is the leading cause of hospitalization in infants. Biomarkers of disease severity may be significant in improving management. Blood secretory acid sphingomyelinase (S-ASM) activity has been recognized as a biomarker of cytokine release, inflammation, oxidative stress, and damage to the vascular endothelium in various diseases. The present study aimed to evaluate whether serum S-ASM activity is increased and correlates with disease severity in infants with RSV bronchiolitis.Methods: Serum S-ASM activity was determined in 31 infants with RSV bronchiolitis, nine infants with RSV-negative febrile infection, and eight healthy infants. Laboratory data including two cytokines, interferon-γ (IFN-γ) and interleukin-18, and clinical observatory findings, including clinical severity score specific for bronchiolitis, were analyzed for correlation with the levels of serum S-ASM activity.Results: Serum S-ASM activity was significantly higher among the 31 infants with RSV bronchiolitis (9.5 ± 5.4 nmol/mL/h) than in those in each of the control groups (RSV-negative febrile infection patients, 4.0 ± 1.4 nmol/mL/h, p<0.005; healthy controls, 4.3 ± 1.9 nmol/mL/h, p<0.005). Serum S-ASM activity negatively correlated with IFN-γ levels (rho=−0.448, p=0.0129), but were not correlated with any other outcomes analyzed in this study.Conclusion: Serum S-ASM activity was significantly higher in infants with RSV bronchiolitis; however, its clinical significance requires further study.
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