Abstract Introduction Human adenoviruses, belonging to the Adenoviridae family, are non-enveloped, double-stranded DNA viruses that typically cause self-limiting respiratory, gastrointestinal, or conjunctival infections in immunocompetent individuals. Although severe adenoviral infections are more frequently observed in immunocompromised hosts, they can occasionally occur in immunocompetent individuals and may even result in fatal outcomes. Here, we report a rare case of severe adenovirus pneumonia in an immunocompetent adult that progressed to acute respiratory distress syndrome and required extracorporeal life support. Case Presentation A 34-year-old woman with a history of asthma and major depressive disorder presented with a four-day history of fever, chills, productive cough with yellowish sputum, and diarrhea. She denied smoking, recent travel, or contact with sick individuals. Empirical antibiotics prescribed at an outpatient clinic provided no improvement. Upon arrival at the emergency department, she was febrile and tachycardic. Chest radiography revealed consolidation in the left lower lobe. Laboratory evaluation showed a white blood cell count of 5,100/µL (neutrophils 85.5%, lymphocytes 9.6%), hemoglobin 13.6 g/dL, platelet count 198,000/ µL, C-reactive protein 10.13 mg/dL, and alanine transaminase 60 U/L. She was admitted with a diagnosis of community-acquired pneumonia and initiated on levofloxacin and piperacillin-tazobactam. Her respiratory status deteriorated rapidly over the following three days, necessitating endotracheal intubation and veno-venous extracorporeal membrane oxygenation (VV-ECMO) for refractory hypoxemia. Chest computed tomography revealed bilateral lower lobe consolidation and ground-glass opacities in the right upper lobe and lingular segment. Diagnostic bronchoalveolar lavage (BAL) detected adenovirus by FilmArray Pneumonia Multiplex PCR panel and viral culture. Tests for Pneumocystis jirovecii, SARS-CoV-2, influenza, cytomegalovirus, Aspergillus species, Cryptococcus, bacterial and fungal pathogens, and acid-fast bacilli were all negative. Serologic tests for Mycoplasma pneumoniae IgM, Chlamydophila pneumoniae IgM, and urinary Legionella antigen were also negative. The patient received intensive supportive care, including intravenous immunoglobulin (IVIG). Gradual clinical improvement was observed, and she was successfully weaned from ECMO and mechanical ventilation. Discussion Although adenoviral pneumonia is well recognized in pediatric and immunocompromised populations, it seldom leads to severe disease in immunocompetent adults. This case highlights the importance of considering adenovirus as a potential causative pathogen in cases of rapidly progressive pneumonia that fail to respond to empiric antibacterial therapy. Early identification and prompt initiation of intensive supportive management, including extracorporeal life support when indicated, are crucial for improving outcomes in severe adenoviral infections. This abstract is funded by: None
Chen et al. (Fri,) studied this question.