Two Cases of Primary Rhinovirus Pneumonia with Multiple Pulmonary Nodules

Abstract

Two patients, a 60-year-old man and 43-year-old woman, presented to our hospital with symptoms of respiratory tract infection. These patients showed imaging findings of multiple small nodules, ground-glass opacities, and consolidations. In case 1, although antibiotics were started, bilateral shadows spread widely, which made us suspect interstitial pneumonia. The condition improved after steroid administration, and there has been no recurrence since completing this treatment. In case 2, the patient recovered rapidly with antibiotics only. In both cases, we performed bronchoalveolar lavage, in which only human rhinovirus infection was detected by multiplex polymerase chain reaction testing, and primary rhinovirus pneumonia was diagnosed.

Keywords: corticosteroid; human rhinovirus; multiplex PCR; nodules; viral pneumonia.

Figure 1.

Chest imaging findings of case 1. Chest X-ray on admission showed nodules in the bilateral lung fields (a). Computed tomography showed diffuse bronchial wall thickening and bilateral small nodules that existed along the airways, but some nodules were randomly distributed (arrows) (b1, 2). Chest X-ray performed on hospital day 10 showed increased bilateral shadows (c). Computed tomography on hospital day 10 showed bilateral consolidations and shrinkage change with bronchodilation and distortion (d).

Figure 2.

Histological findings of case 1. A transbronchial lung biopsy showed the accumulation of macrophages with few eosinophils and neutrophils. Exudates of fibrins and mild alveolitis were also found.

Figure 3.

Chest imaging findings of case 2. Chest X-ray showed bilateral consolidation (a). Computed tomography showed bilateral ground-glass opacities and centrilobular nodules (b, c).