CTICasesHerpes Simplex Virus Type 1 Pneumonia
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Imaging findings
Chest CT of a kidney transplant recipient shows a rapidly progressive, confluent crazy-paving pattern of ground-glass opacities, areas of consolidation, septal lines, and small pleural effusions. Bronchoalveolar lavage fluid PCR is positive for HSV-1, with all other viral and bacterial cultures negative.
Key takeaways
Herpes simplex virus type 1 (HSV-1) is an uncommon but severe cause of viral pneumonia in immunocompromised hosts, such as solid organ transplant recipients. Unlike other viral pneumonias that typically cause bronchiolitis-like patterns, HSV-1 pneumonia can mimic a dense, confluent bacterial bronchopneumonia or progress rapidly to ARDS and tracheobronchitis.
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