A Case of Respiratory Syncytial Virus Infection in an HIV-Positive Adult

Respiratory syncytial virus (RSV) is commonly known to cause an influenza-like illness. However, it can also cause more severe disease in young children and older adults comprising of organ transplant patients with immunocompromised status. Till date, only four cases of RSV infections have been reported in HIV-positive adults. We describe here a case of HIV-positive female with relatively preserved immune function who presented with RSV infection requiring ventilation and showed improvement after prompt treatment with intravenous immunoglobulin. 1. Introduction Respiratory syncytial virus (RSV) is a common virus widely known to cause acute respiratory tract illness in people of all ages. Young immunocompetent children are more frequently infected, and reinfection is common. However, it has come to be recognized as a serious adult pathogen in recent times. Epidemiological studies indicate that RSV is second to influenza as a cause of serious viral respiratory disease in adults [1]. Immunocompromised adults may have RSV in varying degrees of severity and outcomes ranging from full recovery to progressive respiratory failure and death. Most case studies involving RSV infection in such patients include hematopoietic stem cell transplant (HSCT) or lung transplant patients [2]. Only four cases have been reported in HIV-positive individuals [3–6]. We describe here a case of 55？y/o HIV-positive female with respiratory failure on mechanical ventilation detected to have RSV infection. 2. Case History We describe a case of an HIV-positive 55-year-old female who presented with worsening shortness of breath, cough and fevers for one-week duration associated with right-sided pleuritic chest pain. Her antiretroviral therapy regimen consisted of Tenofovir/Emtricitabine, Ritonavir, and Darunavir daily. Her CD4 count on admission was 408/mm3 with undetectable viral load. Patient was febrile to a maximum temperature of 102？F, hypotensive with systolic blood pressure recorded in the range of 80–90？mm？Hg, and hypoxic with oxygen saturation of 90% on room air. On auscultation, she had bilateral crackles anteriorly. Chest X-ray demonstrated right-sided pleural effusion with bibasilar opacities. On admission, patient had acute renal failure with a creatinine of 4.3. In the emergency department, patient received ceftriaxone and azithromycin as empiric coverage for community-acquired pneumonia, intravenous fluids, and bronchodilators. Her respiratory status declined overnight with worsening hypoxia requiring intubation and mechanical ventilation. Repeat chest X-ray showed