Successful treatment of parainfluenza virus 3 pneumonia with oral ribavirin and methylprednisolone in a bone marrow transplant recipient

Int J Hematol. 2008 Oct;88(3):336-340. doi: 10.1007/s12185-008-0148-6. Epub 2008 Aug 19.


We report a case of severe parainfluenza (PIV) 3 pneumonia in a hematopoietic stem cell transplant recipient that was successfully treated with oral ribavirin and methylprednisolone. A 42-year-old woman diagnosed with acute myelogenous leukemia (FAB M5a) in first complete remission underwent allogeneic bone marrow transplantation from an HLA-matched unrelated donor in May 2006. In July 2007, she developed PIV3 pneumonia. Her respiratory status progressively worsened and she required O(2) inhalation at 6 L/min. After an informed consent was obtained, oral ribavirin was initiated (16 mg/kg per day) for 1 week on July 31. By day 3 of treatment, the high-grade fever had disappeared. However, it recurred after ribavirin was discontinued. In addition, the patient's hypoxia continued to worsen, requiring O(2) inhalation at 9 L/min. To suppress the inflammatory reaction in the lung caused by PIV3 pneumonia, intravenous methylprednisolone (1,000 mg once a day for 3 days) was started along with high-dose oral ribavirin (16 mg/kg per day) on August 11. The patient showed dramatic clinical improvement, and oxygen inhalation was discontinued on September 3. Our case suggests that with concomitant effective anti-viral treatment, corticosteroids may suppress host inflammatory or immune reactions that lead to respiratory failure.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Adult
  • Anti-Inflammatory Agents / administration & dosage*
  • Antiviral Agents / administration & dosage*
  • Bone Marrow Transplantation*
  • Female
  • Humans
  • Leukemia, Myeloid, Acute / therapy
  • Methylprednisolone / administration & dosage*
  • Parainfluenza Virus 3, Human*
  • Pneumonia, Viral / drug therapy*
  • Respirovirus Infections / drug therapy*
  • Ribavirin / administration & dosage*
  • Transplantation, Homologous


  • Anti-Inflammatory Agents
  • Antiviral Agents
  • Ribavirin
  • Methylprednisolone