Abstract Introduction HSV Pneumonitis is a lower respiratory tract infection commonly caused by HSV-1 which usually occurs in Immunocompromised patients and critically ill patients who have multiple risk factors like advanced age, immunosuppression, prolonged mechanical ventilation etc. Often, it is challenging to diagnose True HSV pneumonitis as there are no strict guidelines. This case highlights an instance when True HSV Pneumonitis was accurately diagnosed involving a comprehensive integration of data from various parameters. Case 60-year-old female with History of ESRD on Peritoneal Dialysis, COPD on home oxygen presented with altered mental status and dyspnea. On presentation she was found to be in septic shock requiring admission to ICU for Broad spectrum antibiotics, fluids and pressor support with mechanical ventilation to address the hypoxemia while continuing to be receiving her PD sessions. Imaging revealed the presence of an infiltrate in the right lower lobe supporting an initial diagnosis of Septic Shock secondary to Pneumonia. However, despite signs of initial improvement her condition deteriorated and had to be reintubated. Ct chest showed Bilateral ground-glass opacities with peri-bronchial thickening prompting a bronchoscopy evaluation; pathology of bronchial washings showed bronchial epithelial cells with mixed inflammatory cells suggestive of a viral etiology and PCR confirmed HSV-1.She was started on renally dosed Acyclovir but due to extensive pressor requirement and significant end- organ damage, the family opted for comfort care and the patient subsequently passed. Discussion The incidence of HSV DNA in BAL/Tracheal aspirate in ventilated/critically ill patients ranges between 10-30% and though most of this is representative of colonization of HSV; it has been shown that about 5-64% of critically ill patients have a re-activation of HSV significantly increasing the odds of developing True HSV Pneumonitis. The mortality rate of critically ill patients with True HSV pneumonitis on prolonged ventilator in ICU in the US is 61.34% and hence it is crucial to promptly detect this diagnosis and intervene at the earliest. True HSV Pneumonitis remains a diagnostic challenge as there is no fixed diagnostic criteria and involves a complex assimilation of evidence including clinical signs of worsening hypoxemia with infiltrates on imaging along with Microbiological detection of HSV in lower respiratory tract via Bronchial washings through PCR and histopathological evidence like viral cytopathic findings like Intranuclear Inclusion bodies, Positive Immunohistochemical staining etc. This abstract is funded by: None
Sundaram et al. (Fri,) studied this question.