Clinical Scorecard: Case Study: Fatal Reactivation of HSV-1 Detected by Sequential mNGS Following ARDS Induced by Intestinal Obstruction in a 91-Year-Old Patient
At a Glance
Category
Detail
Condition
Herpes Simplex Virus Type 1 Reactivation
Key Mechanisms
Reactivation of HSV-1 following acute stress and immunosuppression leading to ARDS.
Target Population
Elderly patients, particularly those with underlying health conditions.
Care Setting
Intensive Care Unit (ICU)
Key Highlights
Rare case of HSV-1 reactivation leading to fatal ARDS in a 91-year-old patient.
Sequential mNGS assays provided dynamic monitoring of pathogen evolution.
Initial microbiological testing was negative despite clinical deterioration.
Multiple organ dysfunction occurred despite aggressive treatment.
The case illustrates the challenges in diagnosing HSV-1 pneumonia.
Guideline-Based Recommendations
Diagnosis
Diagnosis of HSV-1 pneumonia relies on PCR or histopathology, but these methods lack sensitivity.
Management
Broad-spectrum antibiotics, antivirals, corticosteroids, and IVIG were utilized, but did not reverse hypoxemia.
Monitoring & Follow-up
mNGS can be used for real-time pathogen tracking in critically ill patients.
Risks
Increased risk of reactivation in elderly patients with acute stress and underlying health conditions.
Patient & Prescribing Data
Critically ill elderly patients with ARDS and potential viral reactivation.
Treatment included broad-spectrum antibiotics and corticosteroids, but antiviral therapy was withheld due to fluid restrictions.
Clinical Best Practices
Consider mNGS for dynamic monitoring of pathogens in critically ill patients.
Evaluate the clinical relevance of HSV-1 in ARDS cases, especially in immunocompromised patients.
Maintain a high index of suspicion for viral reactivation in elderly patients with acute stress.
