Herpes Simplex Virus Type 1 with Concomitant Pneumonia and Urinary Tract Infection in an Older Patient: A Case Report

Abstract

A 76-year-old female patient was unable to ambulate due to sequelae of cerebrovascular disease and had been living in a healthcare facility. On admission, the patient was diagnosed with sepsis and a urinary tract infection caused by Candida tropicalis. Chest radiography showed right lung atelectasis, while bronchoscopy showed bronchial stenosis with anthracotic pigmentation in both bronchi. Bronchial washing cytology revealed herpes simplex virus (HSV) type 1-infected cells with intranuclear inclusions and multinucleation on the 7th day. Moreover, the patient showed microscopic hematuria. Urine cytology also revealed HSV type 1-infected cells. The patient was treated with antiviral (acyclovir), antifungal, and antibiotic agents. One week later, follow-up urine cytology revealed the absence of HSV infection, and her condition was stabilized. However, her clinical condition deteriorated due to an infection caused by multidrug-resistant bacterial pathogens, and she eventually died 4 weeks after admission. We describe a case of HSV type 1 pneumonia and urinary tract infection in an older adult patient.

Keywords: Cytology; Herpes simplex virus; Pneumonia; Urinary tract infections.

Fig. 1.

(A) Chest radiography on admission showing diffuse increased opacity in the right hemithorax with right upper lobe atelectasis and collapse consolidation. (B, C) Chest computed tomography on admission showing consolidation in the right lung and combined atelectasis with obliteration in the right main bronchi. Small consolidation is also visible in the left upper lobe. (D) Chest radiography showing no change in the atelectasis of the right upper lobe after acyclovir treatment.

Fig. 2.

Bronchoscopy showing narrowing of the right main bronchus with anthracotic pigmentation. (A) Right main bronchus stenosis at the carinal level. (B) Right upper lobe atelectasis with anthracotic pigmentation at the right main bronchus.

Fig. 3.

Bronchial washing cytology showing intranuclear inclusion and multinucleation, suggesting herpes simplex virus-infected cells (Papanicolaou stain, × 400).