Respir Case Rep. 2015; 4(2): 101-104 | DOI: 10.5505/respircase.2015.86547

An Unexpected Cause of Diffuse Alveolar Hemorrhage in an Immunocompetent Young Patient: Herpes Simplex Type 1 Related Pneumonia

Mevlüt Karataþ¹, Halit Çýnarka¹, Servet Kayhan¹, Aziz Gümüþ¹, Recep Bedir², Songül Özyurt¹, Ünal Þahin^1
1Department of Pulmonology, Recep Tayyip Erdoðan University Faculty of Medicine, Rize, Turkey
²Department of Pathology, Recep Tayyip Erdoðan University Faculty of Medicine, Rize, Turkey

An 18-year-old man was admitted to the hospital with the complaints of dyspnea, cough and hemoptysis. The physical examination revealed, herpes labials on the lower lip and crackles in the middle and lower regions of both lungs. Laboratory tests revealed a leukocyt count of 21.700/mm3, hemoglobulin level of 6.80 g/dL, hematocrit of 23.2%, CRP of 5.46 mg/dl, and HSV-1 IgM was positive. The thorax CT revealed bilateral and diffuse ground glass appearance and interlobuler septal thickening on both pulmonary paranchymal areas. Active bleeding was observed in the entire tracheobronchial system by bronchoscopy. Microscopic images showed hemosiderin-loaded macrophages. We diagnosed HSV-1 related pneumonia and diffuse alveolar hemorrhage (DAH). We treated the patient with acyclovir, corticosteroid, erythrocyte suspension, cryoprecipitate, and tranexamic acid. The patient improved dramatically. Finally, while HSV-1 related pneumonia is usually seen in immunocompromised hosts and critically ill patients, in the present case, a healthy immunocompetent man was infected with HSV-1. Following medication, the patient was completely healed. We think that the current case is a rare disease of HSV-1 leading to DAH.

Keywords: Herpes simplex virus, pneumonia, diffuse alveolar hemorrhage.

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Ýmmunitesi Saðlam Genç Bir Hastada Beklenmedik Sebebe Baðlý Diffüz Alveoler Hemoraji; Herpes Simplex Tip-1 Ýliþkili Pnömoni

Mevlüt Karataþ¹, Halit Çýnarka¹, Servet Kayhan¹, Aziz Gümüþ¹, Recep Bedir², Songül Özyurt¹, Ünal Þahin^1
1Recep Tayyip Erdoðan Üniversitesi Týp Fakültesi, Göðüs Hastalýklarý Anabilim Dalý, Rize
²Recep Tayyip Erdoðan Üniversitesi Týp Fakültesi Patoloji Anabilim Dalý, Rize

On sekiz yaþýnda erkek hasta nefes darlýðý, öksürük, kanlý balgam þikâyetiyle hastanemize baþvurdu. Fizik bakýda vital bulgularý normaldi. Alt dudakta herpes labialis ve akciðerler orta-alt bölgede inspiratuar raller mevcuttu. Laboratuvarýnda lökosit 21.700/mm3, hemoglobin 6,80 g/dL, hematokrit %23,2, CRP 5,46mg/dl ve viral panelinde HSV-1 IgM pozitifti. Toraks BT’de her iki akciðerde diffüz buzlu cam opasitesi, interlobuler septal kalýnlaþmalar görülmekteydi. Fiberoptik bronkoskopide trakeobronþial sistemde diffüz eritem ve kanama saptandý. Bronkoalveoler lavajda hemosiderin yüklü makrofajlar görüldü. HSV-1’e baðlý pnömoni ve diffüz alveoler hemoraji (DAH) düþünülen hastaya acyclovir, kortikosteroid, eritrosit süspansiyonu, taze donmuþ plazma ve tranexamik asit baþlandý. Tedaviye dramatik cevap geliþti. Sonuç olarak, HSV-1 pnömonisinin sýklýkla immün suprese ve yoðun bakým hastalarýnda görüldüðü bilinmesine karþýn olgumuzda immünitesi normal, genç bir hastada HSV-1’e baðlý pnömoni ve DAH kliniðinin geliþtiðini görmekteyiz. Bu olgunun HSV-1’e baðlý geliþen, DAH patolojisiyle seyreden ve seyrek görülen bir olgu olduðu kanýsýndayýz.

Anahtar Kelimeler: Herpes simplex virus, pnömoni, diffüz alveoler hemoraji.

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