A sheep in wolf's clothing? Herpes-simplex-virus endobronchial pseudotumor

Abstract

Central airway obstruction (CAO) is generally defined as airflow limitation due to >50 % occlusion and is most commonly due to malignant etiologies. However, benign etiologies, including herpes-simplex-virus (HSV) endobronchial pseudotumor, can occur. Due to the rarity of HSV causing airway obstruction, an evidence-based approach to the bronchoscopic resection and standardization of therapy after removal are lacking. Herein, we present a case of HSV pseudotumor successfully managed by argon-plasma-coagulation (APC) debulking via bronchoscopy and medical management with intravenous foscarnet due to failed treatment with acyclovir for previous HSV lesions.

Keywords: Argon plasma coagulation (APC); Central airway obstruction (CAO); Herpes-simplex-virus (HSV) pseudotumor; Human immunodeficiency virus (HIV).

Fig. 1

A CT Chest that was obtained before intubation. This demonstrated left sided consolidation, infiltrate, mucus plugging and impaction of the left mainstem bronchus (red arrow), which was suspicious for a post-obstructive process secondary to possible neoplasm. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Initial fiberoptic flexible bronchoscopy via GlideScope shortly after urgent endotracheal intubation. This was performed by overnight critical care revealing a white, fleshy, and nodular mass with mucus impaction. Biopsy not done due to concern for malignancy and to avoid additional bleeding.

Fig. 3

Follow-up fiberoptic flexible bronchoscopy was performed a few days after initial endotracheal intubation and flexible bronchoscopy. This image shows a white, nodular tumor suspicious for malignancy after multiple forceps biopsies and before APC debulking.