Fatal pulmonary complications in an immunodeficient child with chronic active Epstein-Barr virus infection | Szczawińska-Popłonyk

Fatal pulmonary complications in an immunodeficient child with chronic active Epstein-Barr virus infection | Szczawińska-Popłonyk

Bottom Line: Seven (70%) patients had infectious pneumonia (adenovirus, herpes simplex, influenza virus, cytomegalovirus, respiratory syncytial virus, and toxoplasmosis), and three patients presented with non-infectious complications (idiopathic pneumonia syndrome and acute pulmonary edema).The “crazy-paving” pattern was bilateral in all cases, with diffuse distribution in nine patients (90%), predominantly in the middle and inferior lung regions in seven patients (70%), and involving the anterior and posterior regions of the lungs in nine patients (90%).The “crazy-paving” pattern is rare in HSCT recipients with pulmonary complications and is associated with infectious complications more commonly than non-infectious conditions. This text unifies this body of knowledge into an educational resource capturing the core competencies required of an emergency radiologist. There were 7 (58%) female and 5 (42%) male patients, with aging between 5 and 50 years (average of 26 years). The CT appearances of bacterial, viral, fungal, tuberculous and mycoplasma respiratory tract infections are discussed. Clinical Approach to Infection in the Compromised Host. Aspergillus, candida, herpes simplex virus, and respiratory syncytial virus are common infectious agents. Thin-section CT evidence of fibrosis has also recently been reported in SARS patients who have been discharged after treatment (9).

Q fever is characterized by a diversity of clinical manifestations, which include prolonged fever, pneumonia, granulomatous hepatitis, and meningoencephalitis (2–7). Invasive pulmonary aspergillosis represents one end of the spectrum of conditions caused by Aspergillus organisms (7). Infectious and non-infections pulmonary complications are common after BMT [1]. CT scoring systems have been proposed in patients with acute respiratory distress syndrome (ARDS) to predict clinical outcomes. Despite advances in diagnosis and treatment, pulmonary infections are a major cause of morbidity and mortality in adult patients. In this review, we discuss the clinical settings that can be combined with radiologic findings to facilitate a more prompt and accurate diagnosis of pulmonary infection in the immunocompromised patient. He required immunosuppressive treatment with systemic corticosteroids (prednisone, methylprednisolone) and azathioprine, along with substitution therapy with thyroxin and growth hormone.

Patients with cystic fibrosis and pulmonary infection with pan-antibiotic resistant organisms (especially Pseudomonas cepacia) have high rates of reinfection after transplant and increased mortality. Perforated duodenal ulcer; Section 1.2. Flank Pain: Case 7. Obstructive uropathy Case 8. Also important is that organisms such as Pseudomonas aeruginosa, ESBL+ enterobacteriaceae and MRSA are much commoner in the immunocompromised. You may need to stay in the hospital for intravenous (IV) antibiotics, or you may be able to treat your pneumonia at home with oral antibiotics. Torres-Tortosam X, Arrizabagalaj X, et al.

Fatal pulmonary complications in an immunodeficient child with chronic active Epstein-Barr virus infection | Szczawińska-Popłonyk
Both clinically and radiologically the heart is small, but this is not easy to assess accurately. Patients with “crazy-paving” patterns detailed in the radiologic report were retrospectively reviewed by two radiologists who were aware that all patients had pulmonary complications; the final decision on the findings was reached by consensus. The pathogens responsible for the infectious episodes were documented by the following methods: bronchoalveolar lavage, sputum culture, and/or autopsy. Despite these treatment and conservative management with oxygen supply, her respiratory difficulty was aggravated. The infections may occur in utero, during passage through the birth canal, or just after birth. In 453 patients with pulmonary infections, the underlying diseases necessitating OLT included hepatitis B virus liver cirrhosis (n=257), acute hepatic failure (n=82), primary biliary cirrhosis (n=57), hepatocellular carcinoma (n=26), post-alcoholic cirrhosis (n=18) and primary sclerosing cholangitis (n=13). Septal thickening can be smooth, nodular or irregular [4].

Even though a patient had a history of malignancy, the patient was considered to be immunocompetent when he or she was in a disease-free state for more than five years. She was not pregnant. 2). However, parainfluenza virus has been detected in 0–8% of adults with community acquired pneumonia.6–9,47,48 Parainfluenza type 3 is more commonly associated with pneumonia than other types, although fewer studies have systematically sought parainfluenza type 4. Characteristic CT appearances in conjunction with broncho-alveolar lavage [8] finding of relative neutrophilia and reduction in the CD4/CD8 ratio, is suggestive of BOOP. In the present case, the patient presented with IPS 16 days after BMT and the diagnosis followed the Clark’s criteria. The patient died in the pediatric anesthesiology and intensive care unit because of multiorgan failure.

Pneumonitis with pulmonary fibrosis can develop 6–8 weeks after the onset of treatment[7]. In contrast to influenza, in which fatal disease generally occurs only in infants, older persons, and persons with underlying medical conditions, severe cases of SARS frequently occurred in previously healthy individuals. Areas of consolidation predominated in the middle/lower pulmonary zones, involving the lower lobes in all of the cases and the middle lobe in one patient. In immunocompromised children, such as those affected by the X-linked lymphoproliferative syndrome (XLPS), with mutations in the gene encoding the signalling lymphocyte activation molecule (SLAM-associated protein, SAP), a fulminating, fatal primary EBV infection may occur [4]. Chronic active EBV infection may result in life-threatening complications, such as accelerated hematological phase also referred to as hemophagocytic lymphohistiocytosis, hematological malignancies and hepatic failure [5]. EBV pneumonia is rare in immunocompetent subjects [6–8]. While mild, usually asymptomatic pneumonitis occurs in about 5-10% of all immunocompetent cases of infectious mononucleosis; severe pulmonary involvement predominantly in the form of interstitial pneumonitis has also been reported to date [9–11].

CAEBV infection has been associated with often life-threatening pulmonary complications most often in adult patients; however, severe fatal EBV-related prominent atypical lymphoid or lymphohistiocytic infiltrates have also been reported in an immunodeficient pediatric patient [12] as well as in immunocompetent young children [13]. Certainly, an immunosuppressive therapy with systemic corticosteroids and azathioprine may have had an important impact on the immune response, defective control of viral replication and development of CAEBV infection in the reported case. Three cases (25%) were diagnosed in the neutropenic phase after the BMT, five (42%) in the early phase and four patients (33%) had the diagnosis in the late phase post-BMT. 1) whereas necrotizing pneumonias are characterized by consolidation with areas of non-enhancement, occasionally with air-fluid levels but without rim enhancement10. Among other causative agents, such bacteria as Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter lwoffii must also be considered in differential diagnostics [16]. In children with viral respiratory infections, in particular with recently emerged pandemic influenza A (H1N1), the interactive mechanisms between viruses and bacteria predispose to bacterial superinfections and development of necrotic pulmonary lesions [17]. There was only one patient with a premorbid lung condition; this patient had childhood asthma.

Air bronchograms or bronchiolograms were noted not only in all three patients with lobar pneumonia (Fig 1) but also in at least one lesion in every case (Fig 2a).

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