A 49‐year‐old man presented with a 1‐week history of fevers, shortness of breath, dry cough, and myalgia. At presentation, his temperature was 103, pulse was 107, and oxygen saturation was 83% on room air. He had diffuse rhonchi on auscultation of the chest. CBC and electrolytes were within normal limits. Chest film showed bibasilar infiltrates. Patient was started on antibiotics for empiric treatment of pneumonia. During the first inpatient night, patient developed respiratory distress requiring intubation and was transferred To the intensive care unit. Viral panel was positive for parainfluenza virus (PIV). Bacterial cultures from blood, sputum, and urine did not grow any pathogens. Patient developed acute respiratory distress syndrome (ARDS). He received oral ribavarin, intravenous immunoglobulin, and steroids with subsequent improvement. Over several weeks, he was weaned off the ventilator and recovered completely.
PIV typically causes mild upper respiratory tract infections but can progress to ARDS, especially in Ihe immunocompromised and elderly. PIV is responsible for 2%‐6% of community acquired pneumonia, in adults. As there are no antiviral agents with proven efficacy for PIV, treatment is largely supportive. Studies have shown variable benefit of using ribavarin with intravenous immunoglobulin in immunocompromised patients. The benefit of intravenous immunoglobulin has not been proven in humans although studies in rats have shown a decrease in PIV titers. Although ribavarin and intravenous immunoglobulin are not standard of care for PIV treatment, the patient in this case report improved.
The purpose of reporting this case is to illustrate an uncommon presentation of PIV as ARDS in an immunocompetent patient and to discuss the use of ribavirin and intravenous immunoglobulin for treatment.
A. deFonseka, none; J. Breaux, III, none.
To cite this abstract:deFonseka A, Breaux J. Parainfluenza Virus: Not Your Typical Atypical. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 245. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/parainfluenza-virus-not-your-typical-atypical/. Accessed December 5, 2019.