Fatal adenoviral necrotizing bronchiolitis case in a post-cardiac surgery intensive care unit

We report a case of a 67 year-old-male patient admitted to the intensive care unit in the post-coronary bypass surgery period who presented cardiogenic shock, acute renal failure and three episodes of sepsis, the latter with pulmonary distress at the 30th post-operative day. The patient expired within five days in spite of treatment with vancomycin, imipenem, colistimethate and amphotericin B. At autopsy severe adenovirus pneumonia was found. Viral pulmonary infections following cardiovascular surgery are uncommon. We highlight the importance of etiological diagnosis to a correct treatment approach.

Fatal adenovirus infections in infants probably infected with HIV.

Adenovirus infections occur commonly in infants and children but are rarely fatal. Although immunosuppression has been associated recently with fatal outcome of adenovirus infections, reports of major morbidity or mortality caused by adenovirus infection in HIV positive patients are infrequent. This is the first report on fatal adenovirus infections in presumably HIV-positive infants in Thailand. Three infants, aged 4, 8 and 5 months, were hospitalized with diagnoses of pneumonia and ARDS, pneumonia with hepatomegaly and ARDS, and pediatric AIDS with pneumonia, respectively. All the infants died within a few weeks after hospitalization. Serologic tests revealed positive anti-HIV in all three infants. Unfortunately, no additional investigation for definite diagnosis of HIV infection was employed. Pathological findings from autopsy and post mortem needle biopsies revealed adenovirus pneumonia in the first two infants, and massive adenovirus infection of the liver in the third infant. Diagnoses were based on characteristic light microscopic pathological findings, and demonstration of viral particles arranged in crystalline arrays in the nucleus of the infected cells by electron microscopy.