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• W4387256598 abstract "SESSION TITLE: Critical Care Case Report Posters 72 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Human metapneumovirus (hMPV) was first discovered in 2001 and is more common among the pediatric population with respiratory disease. Although adult infections are rare, usually elderly and immunocompromised patients can be affected by this virus leading to Acute respiratory distress Syndrome (ARDS). We present a case of hMPV infection leading to ARDS in a 45-year-old immunocompetent patient. CASE PRESENTATION: A 45-year-old female with a past medical history of hypertension, type 2 diabetes mellitus, and hyperlipidemia, presented with complaints of shortness of breath, cough with sputum production, fever, and chills for 1 week. On presentation, she was febrile to 39.2°C, tachycardic, and tachypneic, saturating >92% on room air. Chest X-ray showed bilateral infiltrates and small pleural effusions. This was followed by a CT scan of the chest, which showed patchy consolidation in the left lower lobe and left upper lobe with diffuse ground-glass and tree-in-bud nodular opacities throughout the lungs. She was found to be negative for COVID-19, RSV, and Influenza. She also did not have any leukocytosis on presentation. Given the imaging findings, she was empirically on antibiotics. She remained febrile over the next 36 hours, and her antibiotics were broadened. Even with broad-spectrum antibiotics, she continued to have fevers up to 39°C and hypoxia requiring oxygen 3L NC. An infectious disease consult was requested, who recommended checking a rapid viral panel, which returned positive for HMPV. Over the next 24 hours, she had worsening hypoxia, requiring High flow Nasal Cannula at 40L 100% FiO2. An ABG showed a pH of 7.37, pCO2 of 34, and pO2 of 87. Repeat imaging with chest X-ray showed worsening bilateral infiltrates, and she was noted to have elevated ESR and CRP consistent with acute respiratory distress syndrome (ARDS) likely from Human Metapneumovirus. She was started on IV steroids. She gradually improved over the next 72 hours with steroids and was weaned to nasal cannula. DISCUSSION: ARDS is defined as an acute, diffuse, inflammatory form of lung injury that can be caused by a variety of etiologies. There are many diagnostic criteria used for ARDS, among which the Berlin criteria define ARDS as a PaO2/FiO2 ratio of <300. Management of ARDS is usually supportive with oxygen supplementation, treatment of the underlying condition, conservative fluid management, and, in selected patients, high-dose glucocorticoid therapy.Our patient had a PaO2/FiO2 ratio of 87, confirming that she had severe ARDS due to HMPV. Our case is unique in the sense that hMPV infection in an immunocompetent middle-aged patient led to ARDS. She was tested for HIV and hepatitis and was found to be negative. Many studies related to hMPV leading to ARDS have been performed in the pediatric population; studies involving adults are few and are mainly in the elderly and immunocompromised patients. CONCLUSIONS: HMPV infection leading to ARDS in the adult population has mainly been described in immunocompromised and elderly population, but this case shows it could also be in a middle-aged immunocompetent patient. Further research is needed on the incidence of hMPV-induced ARDS in the immunocompetent adult population. REFERENCE #1: Tran D H, Sameed M, Marciniak E T, et al. (July 17, 2021) Human Metapneumovirus Pneumonia Precipitating Acute Respiratory Distress Syndrome in an Adult Patient. Cureus 13(7): e16434. doi:10.7759/cureus.16434 DISCLOSURES: No relevant relationships by Paul Stendahl Dy No relevant relationships by Micaela Kristina Paz No relevant relationships by Sushrutha Sridhar No relevant relationships by Shashi Yalamanchili" @default.
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• W4387256598 date "2023-10-01" @default.
• W4387256598 modified "2023-10-03" @default.
• W4387256598 title "HUMAN METAPNEUMOVIRUS-INDUCED ACUTE RESPIRATORY DISTRESS SYNDROME" @default.
• W4387256598 doi "https://doi.org/10.1016/j.chest.2023.07.1834" @default.
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