Disseminated Herpes Simplex Virus in Immediate Post Lung Transplant Patient

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Introduction: Herpes simplex virus (HSV) infections are a significant concern for patients following solid organ transplantation (SOT), given the complex interplay between immunosuppression and viral reactivation. HSV-1, to a much lesser degree HSV-2, can cause a range of manifestations in these patients, from mild mucocutaneous lesions to severe systemic disease, depending on factors such as the level of immunosuppression, prior viral exposure, and overall patient health 1.

Case Presentation: We present a 67-year-old female with a past medical history of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and a usual interstitial pneumonia (UIP) pattern, chronic hypoxia on home oxygen as well as multiple Staphylococcus aureus respiratory infections. She was admitted for acute hypoxemic respiratory failure (AHRF) due to MSSA pneumonia and she was treated with antibiotics and corticosteroids. During her hospital stay, she experienced worsening of her underlying lung disease, leading to a decision to activate her for lung transplantation. Following respiratory deterioration, she was initiated on Veno-venous extracorporeal membrane oxygenation (VV-ECMO), and ultimately underwent bilateral lung transplantation.Ano-genital lesions were noted post operative day 4, and PCR was positive for HSV-2. Blood was positive for HSV PCR on post operative day 5. During bronchoscopy ulcers were noted in the left mainstem bronchus and were found to be positive HSV-2 PCR. On lumbar puncture (LP), CSF HSV was negative. Unfortunately, she remained critically ill after her transplant and she developed further infections with worsening septic shock. Due to severe shock, she developed diffuse mesenteric ischemia, which was not survivable and she was transitioned to comfort care. Discussion Disseminated HSV-2 after lung transplant has been reported from donor derived infection (2). In our patient, we believe she derived disseminated disease from reactivation of recipient ano-genital disease in the setting of immunosuppression before (corticosteroids) and after (induction and maintenance immunosuppression) lung transplantation. Evidence supporting recipient derived infection include HSV-2 positive IGG in the recipient prior to transplant, early ano-genital ulcers, and lack of HSV-2 infection in the other organ recipients from the same donor. To our knowledge, this is the first report of recipient derived disseminated HSV-2 (blood, respiratory tract, ano-genital) in the immediate post operative phase after lung transplant. Our report suggests a low threshold to test for HSV in a transplant recipient with any mucocutaneous ulcerations. Airway ulcers may also be an indication for HSV disease especially in those that are critically ill and unable to provide history.Left Mainstem Bronchus Ulcers

Volume

211

First Page

A7890

Last Page

A7890

Comments

American Thoracic Society International Conference, May 16-25, 2025, San Francisco, CA

DOI

10.1164/ajrccm.2025.211.Abstracts.A7890

ISSN

1535-4970

Link to Full Text

Share

COinS