Intravenous vitamin C as adjunctive therapy for enterovirus/rhinovirus induced acute respiratory distress syndrome

Abstract

We report a case of virus-induced acute respiratory distress syndrome (ARDS) treated with parenteral vitamin C in a patient testing positive for enterovirus/rhinovirus on viral screening. This report outlines the first use of high dose intravenous vitamin C as an interventional therapy for ARDS, resulting from enterovirus/rhinovirus respiratory infection. From very significant preclinical research performed at Virginia Commonwealth University with vitamin C and with the very positive results of a previously performed phase I safety trial infusing high dose vitamin C intravenously into patients with severe sepsis, we reasoned that infusing identical dosing to a patient with ARDS from viral infection would be therapeutic. We report here the case of a 20-year-old, previously healthy, female who contracted respiratory enterovirus/rhinovirus infection that led to acute lung injury and rapidly to ARDS. She contracted the infection in central Italy while on an 8-d spring break from college. During a return flight to the United States, she developed increasing dyspnea and hypoxemia that rapidly developed into acute lung injury that led to ARDS. When support with mechanical ventilation failed, extracorporeal membrane oxygenation (ECMO) was initiated. Twelve hours following ECMO initiation, high dose intravenous vitamin C was begun. The patient's recovery was rapid. ECMO and mechanical ventilation were discontinued by day-7 and the patient recovered with no long-term ARDS sequelae. Infusing high dose intravenous vitamin C into this patient with virus-induced ARDS was associated with rapid resolution of lung injury with no evidence of post-ARDS fibroproliferative sequelae. Intravenous vitamin C as a treatment for ARDS may open a new era of therapy for ARDS from many causes.

Keywords: Acute lung injury; Acute respiratory distress syndrome; Enterovirus/rhinovirus; Extracorporeal membrane oxygenation; Intravenous vitamin C.

Figure 1

Patient’s anterior-posterior chest X-ray film prior to intubation.

Figure 2

Patient’s anterior-posterior chest X-ray film on extracorporeal membrane oxygenation day 1.

Figure 3

Patient’s anterior-posterior chest X-ray film on extracorporeal membrane oxygenation day 2.

Figure 4

Patient’s anterior-posterior chest X-ray film on extracorporeal membrane oxygenation decannulation, extubation day 7.

Figure 5

Patient’s posterior-anterior chest X-ray film two weeks following hospital discharge.