Secondary pneumonia from herpes simplex is not so simple: A case report

Area of Science:

• Pulmonology
• Infectious Diseases
• Virology

Background:

• Community-acquired pneumonia (CAP) can lead to severe respiratory failure.
• Bacterial pneumonia is the most common cause of CAP.
• Herpes simplex virus (HSV) pneumonia is a rare complication, particularly in immunocompetent individuals.

Observation:

• A 33-year-old immunocompetent female presented with severe CAP, tachypnea, tachycardia, and leukocytosis.
• Initial investigations, including bronchoscopy and cultures, were negative for bacterial pathogens.
• Despite mechanical ventilation and extracorporeal membrane oxygenation (ECMO), respiratory failure persisted.

Findings:

• Repeat bronchoscopy revealed characteristic targetoid ulcerative lesions in multiple lung lobes.
• Histopathological examination and subsequent testing confirmed Herpes Simplex Virus (HSV) pneumonia.
• The patient's condition occurred concurrently with an acute bacterial infection.

Implications:

• This case underscores the potential for HSV pneumonia in immunocompetent patients presenting with severe CAP, especially when initial bacterial workup is unrevealing.
• It emphasizes the need for a broader differential diagnosis in refractory respiratory failure.
• Early recognition and consideration of viral etiologies like HSV are crucial for appropriate management and improved patient outcomes.