Treatment of Adenoviral Acute Respiratory Distress Syndrome Using Cidofovir With Extracorporeal Membrane Oxygenation

• Published in: Journal of intensive care medicine 2017-03, Vol.32 (3), p.231-238
• Main Authors: Lee, Minhyeok, Kim, Seulgi, Kwon, Oh Jung, Kim, Ji Hye, Jeong, Inbeom, Son, Ji Woong, Na, Moon Jun, Yoon, Yoo Sang, Park, Hyun Woong, Kwon, Sun Jung
• Format: Article
• Language: English
• Subjects: Adenovirus Infections, Human - complications; Adenovirus Infections, Human - diagnostic imaging; Adenovirus Infections, Human - physiopathology; Adenovirus Infections, Human - therapy; Antiviral Agents - therapeutic use; Cytosine - analogs & derivatives; Cytosine - therapeutic use; Extracorporeal Membrane Oxygenation - methods; Female; Humans; Immunocompromised Host - drug effects; Male; Middle Aged; Organophosphonates - therapeutic use; Pneumonia, Viral - complications; Pneumonia, Viral - diagnostic imaging; Pneumonia, Viral - physiopathology; Pneumonia, Viral - therapy; Radiography; Respiratory Distress Syndrome, Adult - diagnostic imaging; Respiratory Distress Syndrome, Adult - physiopathology; Respiratory Distress Syndrome, Adult - therapy; Respiratory Distress Syndrome, Adult - virology; Severity of Illness Index; Treatment Outcome; Young Adult
• ISSN: 1525-1489
• DOI: 10.1177/0885066616681272

Adenovirus infections are associated with respiratory (especially upper respiratory) infection and gastrointestinal disease and occur primarily in infants and children. Although rare in adults, severe lower respiratory adenovirus infections including pneumonia are reported in specific populations, such as military recruits and immunocompromised patients. Antiviral treatment is challenging due to limited clinical experience and lack of well-controlled randomized trials. Several previously reported cases of adenoviral pneumonia showed promising efficacy of cidofovir. However, few reports discussed the efficacy of cidofovir in acute respiratory distress syndrome (ARDS). We experienced 3 cases of adenoviral pneumonia associated with ARDS and treated with cidofovir and respiratory support, including extracorporeal membrane oxygenation (ECMO). All 3 patients showed a positive clinical response to cidofovir and survival at 28 days. Cidofovir with early ECMO therapy may be a therapeutic option in adenoviral ARDS. A literature review identified 15 cases of adenovirus pneumonia associated with ARDS.