CTICasesHuman Metapneumovirus Infection causing Acute Respiratory Distress Syndrome
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Imaging findings
Serial chest radiographs in a leukemia patient status-post stem cell transplant demonstrate a rapid progression of lung disease over one week. The initial radiograph is normal, followed three days later by focal nodules in the left mid-lung, and finally progressing to dense, confluent bilateral consolidations and diffuse alveolar damage, necessitating mechanical intubation. Viral PCR of the respiratory tract was positive for human metapneumovirus.
Key takeaways
Human metapneumovirus is a paramyxovirus that can cause severe, life-threatening lower respiratory tract infections in immunocompromised individuals, particularly hematopoietic stem cell transplant recipients. It can rapidly progress from localized nodules to diffuse, consolidative acute respiratory distress syndrome (ARDS) that is radiologically indistinguishable from other severe viral pneumonias (such as influenza) or opportunistic infections. Early viral PCR testing is essential for prompt diagnosis and supportive care in this high-risk population.
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