Clinical picture

HSV pneumonia and endobronchial clusters of vesicles Herpes simplex virus (HSV) pneumonia is a rare disease and almost exclusively occurs in immuno-compromised patients, such as those with malnutri-tion, malignancy, burns, severe pulmonary disease or human immunodeficiency virus infection.1 The pathological features of HSV pneumonia include necrotizing tracheobronchitis, necrotizing pneumo-nia and interstitial pneumonitis.2 The diagnosis of HSV pneumonia is based on microscopic findings of characteristic cytopathic cellular changes, such as intranuclear inclusions or homogenization of the nuclear chromatin, in specimens obtained by bron-chial brushing, bronchoalveolar lavage or tissue biopsy.3 We report a case of HSV pneumonia presenting characteristic clusters of vesicles on bronchial mucosa. An 86-year-old man with chronic obstructive pulmonary disease presented to the hospital after 4 days of fever, cough and shortness of breath. His initial examination revealed tachycardia (138 beats/ min) and hypoxemia (80 % oxygen saturation on am-bient air). Computed tomographic imaging revealed ground-glass opacities over the right lower lobe (RLL; Figure 1a). Bronchoscopy revealed clusters of small, tense vesicles on the RLL bronchial mucosa (Figure 1b). A viral isolate from bronchoalveolar lavage fluids (BALF) obtained from the RLL disclosed type 1 HSV. BALF cytology showed HSV-infected epithelial cells, characterized by multinucleation with glassy nuclei and eosinophilic intranuclear inclusions. The patient underwent a tracheostomy for prolonged ventilator use. Following intravenous acyclovir (15mg/kg/day) for 21 days, he was success-fully weaned from mechanical ventilation and was subsequently discharged from the hospital