Herpes Simplex Virus Pneumonia Mimicking Legionella Pneumonia in an Elderly Patient With Heart and Liver Failure

Abstract

The diagnosis of viral pneumonia is often difficult because of its varied presentations. Regarding the serological diagnosis of viral infections, it is difficult to perform a viral DNA test in general medical facilities, especially in rural settings. Among viral pneumonia cases, herpes simplex virus (HSV) pneumonia can occur in immunocompromised hosts. However, when the clinical course of HSV pneumonia is acute, and the features of pneumonia are not distinct, the diagnosis can be challenging. We report the case of a 69year-old man who visited the hospital with complaints of dyspnea and cough for two days. Although the patient had no fever and the urine was negative for Legionella antigen, we suspected Legionella pneumonia based on the clinical course, Gram stain of sputum, and CT findings. After undergoing treatment with antibiotics, his condition worsened, with dyspnea and an increase in the demand for oxygen at 5 L. The patient also had complications related to the heart and liver. The sputum culture was negative, and the HSV serum test revealed that HSV IgM level was elevated to 1.16 (reference value: ≤0.80) and IgG level at admission and at follow-up 21 days later was elevated to 28.1 and 60.0 respectively (reference value: ≤2.0); accordingly, the patient was diagnosed with HSV pneumonia. In cases of pneumonia with atypical courses, the coexistence of multiple diseases, and immunosuppression, HSV pneumonia should be included in the differential diagnosis. In rural settings, viral pneumonia should be investigated using antibodies against viruses due to the limited availability of other medical resources. When a patient is judged to be immunosuppressed in the treatment of pneumonia of unknown cause, it is important to consider the possibility of HSV infection and take prompt action. Furthermore, it is essential to consider the possibility of multi-organ failure secondary to HSV infection, which requires systemic management.

A single-center, retrospective study of hospitalized patients with lower respiratory tract infections: clinical assessment of metagenomic next-generation sequencing and identification of risk factors in patients

“…Evidence of herpes simplex virus invasion of the mucosa, unexplained infiltrates, and persistent deterioration despite appropriate antibiotic treatment for ventilator-associated pneumonia, as well as histopathological changes observed in HSV-1 isolated from blood or BALF, provide clues suggesting herpes simplex virus as the causative agent. Furthermore, this viral infection is associated with an increased mortality rate among hospitalized patients [61]. Goodness-of-fit tests demonstrate a strong fit between the predicted and actual probabilities in the model.…”

Autoimmune Vasculitis Causing Acute Bilateral Lower Limb Paralysis

“…To ensure the provision of effective community medical care services in the future, it is necessary to promote appropriate and prompt visits to healthcare facilities. Moreover, it is necessary to educate patients in the community on the symptoms of disease recurrence and appropriate treatment behaviors [ 19 , 20 ]. The ability to respond to rapidly progressive conditions based on appropriate treatment behaviors is important for facilitating the diagnosis of chronic inflammatory diseases, including vasculitis.…”

Seronegative Rheumatoid Arthritis in an Elderly Patient With Anemia: A Case Report

“…Inflammation generally progresses slowly, and the reduction in Hb levels is rarely severe [ 8 ]. However, older adults and patients with dementia may develop severe anemia without any subjective symptoms such as pain [ 16 , 17 ]. Older patients with vague symptoms require comprehensive care using systemic approaches in rural contexts [ 18 ].…”