HUMAN RHINOVIRUS INFECTION CAUSING ARDS IN AN IMMUNOCOMPETENT HOST

ABSTRACT

SESSION TITLE Critical Care in Chest Infections Case Report Posters 1 SESSION TYPE Case Report Posters PRESENTED ON 10/17/2022 1215 pm - 0115 pm INTRODUCTION: The "common cold” is a syndrome defined by upper respiratory symptoms in addition to rhinorrhea, fever, chills, headache, and/or malaise. Classically "colds” are thought of as a mild, self-limiting disease;however, they can cause severe respiratory symptoms in immunocompetent individuals. We present a case of severe acute respiratory distress syndrome (ARDS) caused by the Human Rhinovirus in an immunocompetent host. CASE PRESENTATION 61-year-old gentleman with a past medical history significant for hypertension presented to an outside hospital for worsening shortness of breath, fatigue, and cough with production x 3 weeks. Social history is notable that he had a 12-pack-year history and quit smoking tobacco approximately 10 years ago. On arrival, the patient was noted to be hypoxic with percent saturation of 88% on 2 L nasal cannula. He rapidly deteriorated and required intubation 5 days after admission. The patient subsequently transferred to a tertiary care intensive care unit for further workup and management. Upon arrival at the tertiary care center, he was found to have a PaO2/FiO2 ratio of 71 and ARDS protocol was initiated. Despite pronation, paralyzation, dexamethasone, and nitric oxide, the patient continued to deteriorate. Three COVID-19 PCR's and COVID-19 antibody resulted negative. Extensive work-up including fungal, autoimmune, viral, and bacterial were negative with the exception of a positive rhinovirus PCR. MRI brain was completed due to patient's unequal pupils which demonstrated numerous recent infarcts of the bilateral cerebral and cerebellar hemispheres with mass-effect with mild leftward shift. The family ultimately decided to pursue comfort measures and the patient died. DISCUSSION: Human Rhinovirus is responsible for ? to ½ of common colds in adults making it the most common cause of "colds.” Due to its more than 100 serotypes, an average adult has approximately 2-3 Rhinovirus infections per year. Rhinovirus infections are classically thought to be self-resolving and mild, particularly in the immunocompetent. However, several recent studies have shown coinfection of the rhinovirus in patients with community acquired pneumonia;although these studies have been unable to tease out how clinically significant the rhinovirus infection was in these patients. The patient case above is an example that the Rhinovirus may be a more important culprit in community-acquired pneumonia than previously suspected. In addition to its possible respiratory conditions, studies have demonstrated an increase in risk of stroke. Currently, there are no FDA-approved antivirals for the Human Rhinovirus, treatment largely aimed to reduce symptomatology. CONCLUSIONS: The medical community, in large, thinks of the Rhinovirus as a relatively benign disease process. Though this may be the case in most patients, even immunocompetent individuals can suffer from serious complications of the virus. Reference #1 Chu HY;Englund JA;Strelitz B;Lacombe K;Jones C;Follmer K;Martin EK;Bradford M;Qin X;Kuypers J;Klein EJ;"Rhinovirus Disease in Children Seeking Care in a Tertiary Pediatric Emergency Department.” Journal of the Pediatric Infectious Diseases Society, U.S. National Library of Medicine, https//pubmed.ncbi.nlm.nih.gov/26908489/. Reference #2 JO;, Proud D;Naclerio RM;Gwaltney JM;Hendley. "Kinins Are Generated in Nasal Secretions during Natural Rhinovirus Colds.” The Journal of Infectious Diseases, U.S. National Library of Medicine, https//pubmed.ncbi.nlm.nih.gov/2295843/. Reference #3 Subramanian, A., et al. "Stroke Following Positive Biomarker for Viral Respiratory Illnesses.” B47. CRITICAL CARE NON-PULMONARY CRITICAL CARE, 2020, https//doi.org/10.1164/ajrccm-conference.2020.201.1_meetings.a3566. DISCLOSURES No relevant relationships by Philip Forys No relevant relationships by Brandon Pearce