Palivizumab for Severe Respiratory Syncytial Virus Infection in Immunocompetent Adults: A Case Series

Abstract

Background: Respiratory syncytial virus (RSV) is a significant cause of lower respiratory tract infections in adults, particularly the elderly, and can lead to severe outcomes, including respiratory failure. Current treatment options for RSV in immunocompetent adults are limited to supportive care.

Objective: This case series aims to describe the clinical course and outcomes of two immunocompetent adults with severe RSV infection treated with Palivizumab, a monoclonal antibody against RSV.

Methods: We report two cases: a 92-year-old female with a history of hypertension and a previous meningioma resection, and a 42-year-old female with no significant past medical history. Both presented with severe respiratory symptoms, were diagnosed with RSV infection via PCR, and received a single dose of intramuscular Palivizumab (approximately 12-13 mg/kg) after initial clinical deterioration despite supportive care and empiric antibiotic therapy.

Results: Following Palivizumab administration, both patients exhibited clinical improvement, including resolution of fever and improvement in oxygenation and radiographic findings. Both patients were discharged in stable condition without the need for supplemental oxygen.

Conclusion: These cases suggest that Palivizumab may be a potential therapeutic option for severe RSV infection in immunocompetent adults. Further research, including randomized controlled trials, is needed to confirm these preliminary findings and establish optimal dosing and treatment protocols.

Keywords: immunocompetent adults; palivizumab; respiratory syncytial virus.

Figure 1

Serial chest plain film of two cases. (A) Case 1 chest X-ray at emergent department; (B) Case 1 chest X-ray on day 4 of admission; (C) Case 2 chest X-ray at emergent department; (D) Case 2 chest X-ray on day 3 of hospitalization; (E) Case 2 chest X-ray on day 5 of hospitalization.