A case report of tracheobronchitis by herpes simplex virus, type I

Abstract

Herpes simplex virus (HSV) infection of the lung and lower respiratory tract has been thought to be a rare and fatal disease, usually in patients with immunosuppression, severe burns, or prolonged intubation. However, recently, increasing numbers of patients have been reported to have a localized infection and some of them have recovered without specific therapy.

In Korea, there has been yet no proven case of HSV infection of the lower respiratory tract. Recently, we saw a case of localized HSV infection of the tracheobronchus. A 78-year-old male patient was admitted in acute respiratory failure, with COPD and old pulmonary trberculosis. After the clinical condition improved, a bronchoscopy was done which revealed a localized area of swelling, hyperemia, and mucosal irregularity at the lower trachea and right upper lobar bronchus. Bronchial brushing and biopsy showed typical cytologic changes including intranuclear inclusion body. Viral culture of a bronchial washing revealed a growth of HSV, type I. The patient died of unrelated, acute myocardial linfarction.

Fig. 1

Chest X-ray at the time of admission. Streaky and patchy densities with volume loss are seen on right upper lung with both lower lung infiltration.

Fig. 2

The first bronchoscopic finding of the lower trachea. Note diffuse erythema, swelling and mucosal irregularity.

Fig. 3

Cytologic finding of the bronchial brushing. Nuclei of the cells show ground-glass appearance with peripheral condensation of chromatin. Note the typical eosinophilic intranuclear inclusion body and multinucleated giant cells (Papanicolau stain, ×900).

Fig. 4

Histopathologic finding of the bronchoscopic biopsy. Severe necrotic inflammation is found with squamous metaplasia. Many of the cells show typical cytologic change seen in Fig. 3 at the high power view. (Hematoxylin and eosin stain, ×100).

Fig. 5

The second bronchoscopic finding of the lower trachea (same area as Fig 2). Multiple irregular patches of pseudomembranes are seen on top of the acute inflammation.