Acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in the ICU setting and a continued source for investigation to improve outcomes. It is characterized by acu..
Acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in the ICU setting and a continued source for investigation to improve outcomes. It is characterized by acute respiratory failure with an identifiable insult, bilateral infiltrates on imaging, and a PaO2/FiO2 ratio (PF ratio) of less than 300 mmHg. It can be further classified into mild, moderate, and severe ARDS with a PF ratio of less than 300, 200, and 100 mmHg respectfully. Treatment requires elucidation of the underlying insult to the pulmonary system and prompt treatment. Presented here is a case of ARDS secondary to herpes simplex virus (HSV) pneumonia in an immunocompetent adult. This patient presented for evaluation during the COVID-19 pandemic with nonspecific respiratory symptoms and bilateral pulmonary infiltrates which would be consistent with COVID pneumonia; however, multiple rapid and PCR COVID-19 nasal testing swabs showed nonreactivity. Her respiratory status ultimately continued to decline while on noninvasive ventilation with Bipap and required intubation. After intubation, a bronchoscopy was performed and bacterial and mycobacterial cultures were obtained and showed no growth. Viral PCR panel was performed and a diagnosis of HSV pneumonia was made. She was started on systemic acyclovir treatment but unfortunately expired before her antiviral course could be completed due to worsening of ARDS and inability to oxygenate. A literature review shows HSV pneumonia to be a rare cause for ARDS especially in the immunocompetent individual with few cases being reported in immunocompetent individuals. Treatment of HSV pneumonia can show reversibility in the lung damage as visualized on imaging which has been shown in another case report. Extracorporeal membrane oxygenation may be utilized as a bridge for treatment when the insult is identified quickly before permanent damage has been done to the lungs. This was unfortunately not an option for this patient due to the limitations of the facility and the time to diagnosis of her condition. This case demonstrates the importance of maintaining a broad differential diagnosis when respiratory status becomes compromised and prompt treatment once an identifiable cause is found.