Systemic Hyperinflammatory States in Association With Viral Lower Respiratory Tract Infections

Objectives: To note the demographic and clinical profile, investigations, therapy instituted, and outcome of viral lower respiratory tract infections (LRTI)-associated systemic hyperinflammation. Methods: Retrospective analysis of hospital records of children admitted between January and March 2023 with viral LRTI-associated hyperinflammation. Hyperinflammation was defined as: Mandatory: (1) Prolonged continuous fever of ≥7 days or change in fever pattern (2) ferritin >1000 ng/mL (3) multisystem involvement (≥2 system) (4) falling trends of at least 2 cell lines (5) negative cultures. Optional: (1) Transaminitis (>3 times the upper limit of normal) (2) albumin (<3.5 gm/dL). Results: A total of 21 patients were included, 13 males and 8 females, median age being 36 months. Median duration of fever at admission was 4 days, and 13 days at diagnosis of hyperinflammation. Fifteen had adenovirus infection, 1 metapneumovirus, 1 corona 229E, and no virus could be isolated in 4 patients. A change in fever pattern along with varying multisystem involvement marked the onset of hyperinflammation. Concurrent investigations showed a fall in the blood cell counts, hyperferritinemia, and hypertriglyceridemia. 30% had normal CRP. All were successfully treated with a short course of dexamethasone, one received methylprednisolone. Conclusion: High index of suspicion is needed to diagnose viral infection-associated hyperinflammation. The onset of multisystem involvement, coupled with hyperferritinemia helps in early identification, and urgent initiation of immunotherapy can arrest the hyperinflammation.