Pneumonia failing to respond to treatment☆

Summary 

Herpes simplex virus type 1 (HSV-1) is frequently isolated from the respiratory tract of critically ill patients. However, diagnosis of clinically significant HSV-1 pneumonia is difficult as the presentation is non-specific and there is no diagnostic reference standard to differentiate from non-infectious contamination.

We present a case of HSV-1 pneumonia in a young asthmatic patient who was potentially immunocompromised through long-term corticosteroid usage. The quantitative PCR titre from bronchoalveolar lavage fluid was high (9×10³copies/ml) and the patient made a dramatic clinical and radiographic recovery upon treatment with acyclovir. We suggest that similar PCR levels in the appropriate clinical setting should prompt consideration of anti-viral therapy.

Keywords: Herpes simplex virus type 1, Pneumonia, Quantitative PCR, Corticosteroids, Immunocompromise