To describe a rare case of fatal HSV-1 reactivation following ARDS induced by intestinal obstruction in a 91-year-old patient, while highlighting the significance of mNGS for pathogen detection.
Approach:
Patient Background: A 91-year-old male with a history of coronary heart disease and hypertension developed ARDS after incomplete intestinal obstruction.
Diagnostic Methods: Five sequential mNGS assays were conducted to monitor pathogen evolution during hospitalization.
Treatment Regimen: The patient received broad-spectrum antibiotics, antifungals, antivirals, corticosteroids, IVIG, and mechanical ventilation.
Key Findings:
Initial mNGS assays did not detect pathogens, while the third BALF mNGS identified predominant HSV-1, indicating a shift in pathogen profile.
Despite aggressive treatment, the patient experienced worsening hypoxemia and multiple organ dysfunction, leading to death.
Routine microbiological testing remained negative throughout the patient's hospitalization, underscoring the limitations of conventional diagnostics.
Interpretation:
This case illustrates the diagnostic challenges and management complexities of HSV-1 reactivation in critically ill elderly patients, with a focus on the role of mNGS in clinical practice.
Limitations:
The interpretation of mNGS results remains complex, as a negative assay cannot exclude infection, and establishing causality between identified pathogens and clinical outcomes is challenging.
Conclusion:
This case provides insights into the dynamics of viral reactivation and the utility of mNGS in monitoring critically ill patients.
