Patrick Wilson, MD, MPH
Associate Professor of Pediatrics and Population and Family Health
Columbia University College of Physicians and Surgeons
New York, New York, United States
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Title: Human Rhinovirus and Severe Pediatric Acute Respiratory Distress Syndrome
Introduction: Human rhinovirus (HRV) has been historically classified as a relatively benign virus infecting the upper respiratory tract. Recent evidence suggests it may play a role in lower respiratory tract infections. Controversy persists as to whether HRV alone can lead to severe pediatric acute respiratory distress syndrome (pARDS).
Description: A 3-year-old previously healthy male presented to the emergency department with increased work of breathing, wheezing and hypoxemia (85%). The respiratory viral panel was positive for HRV and chest radiograph revealed multifocal patchy opacities. He was treated for an asthma exacerbation with beta-agonists, given antibiotics for pneumonia and admitted to the pediatric intensive care unit (PICU) on bilevel positive airway pressure (BPAP). He remained profoundly hypoxemic despite high levels of oxygen administration. An echocardiograph with bubble study was normal. He required endotracheal intubation on hospital day 3 for hypoxemic respiratory failure and had a PaO2 to FiO2 ratio of 66 and an OI of 19 (severe pARDS). Blood cultures were negative and a bronchoscopy was performed on hospital day 5 which was unremarkable with negative bacterial and fungal cultures, aspergillus galactomannan and pneumocystis jiroveci. He suffered a bradycardic arrest on hospital day 8 requiring seven minutes of chest compressions. Immunology was consulted for a possible underlying immunodeficiency given his severe presentation but the work-up was negative. A chest computed tomography with angiography (CTA) was performed and demonstrated extensive lower lobe consolidations and no intrapulmonary shunts. The ventilator was weaned gradually over the course of a few weeks and the patient was successfully extubated to BPAP on hospital day 24 and discharged home on hospital day 39 with no major morbidities.
Discussion: There is a growing body of evidence suggesting HRV may cause severe lung disease in previously healthy pediatric patients. Here we report a case of severe pARDS and cardiac arrest associated with the presence of HRV after an extensive workup. Further studies are needed to definitively determine if HRV as a sole pathogen can lead to severe pARDS and to elucidate host risk factors that may lead to severe disease.