Young adult with near-fatal pneumonia caused by adenovirus serotype 7

We report a case of severe adenoviral pneumonia in an immunocompetent male athlete. His presentation included dyspnea, cough, tachypnea, hypoxemia, rapidly progressive bilateral lung infiltrates, tracheobronchitis with bronchorrhea, left pleural effusion, and leukopenia with lymphocytosis. His course was complicated by thrombophlebitis despite prophylaxis, and by weight loss and alopecia. The etiology was adenovirus (serotype 7), which grew from bronchoalveolar lavage fluid and from pleural fluid. His oxygenation was much improved by bi-level positive airway pressure mask ventilation, which allowed him to avoid endotracheal intubation and mechanical ventilation during a three-week intensive care unit stay. Prior to discharge his pulmonary function test revealed severe restrictive lung disease. The total lung capacity was 58% of predicted and the diffusing capacity was 52% of predicted. His arterial blood gas showed hypoxemia at rest, with an arterial oxygen tension of 60 mm Hg on room air and arterial desaturation during exercise. All values returned to near-normal within six months and he was able to resume strenuous exercise without difficulties, and 22 months after this acute illness the patient was clinically well.