Successful treatment of severe parainfluenza pneumonia in a liver transplant recipient with oral ribavirin and intravenous immunoglobulin

Abstract

The most common viruses affecting immunocompromised hosts include cytomegalovirus, herpes simplex virus, varicella-zoster virus, influenza virus, measles virus, and adenovirus. Parainfluenza virus infection is common among human populations. It causes non-specific symptoms in immune-competent hosts; therefore, it may go undiagnosed. However, it is particularly dangerous for immunocompromised patients by presenting a high risk of morbidity and sometimes mortality among them. Patients who have bone marrow or solid organ transplantation need to follow an intense immunosuppressing routine, which leaves them extremely vulnerable to opportunistic agents such as parainfluenza viruses. Several factors determine the severity of parainfluenza virus infections, such as the type of the virus, the level of immunosuppression, and co-infection with other agents. Co-infection is especially important because it makes a correct differential diagnosis difficult. While almost all bodies of influenza infection information in immunocompromised patients are from studies of bone marrow transplant recipients, there are very limited data available on influenza infections in liver transplant patients. We present a liver transplant patient with severe parainfluenza pneumonia that was improved significantly with oral ribavirin and intravenous immunoglobulin. A 23-year-old female patient with a history of liver transplantation from 18 months ago presented with a one-week cough and tachypnea. Chest computed tomography demonstrated ground-glass opacities and diffuse infiltrates throughout both lungs. A multiplex polymerase chain reaction for the detection of respiratory viruses in the nasopharynx was positive for parainfluenza virus type 3 and she was successfully treated with oral ribavirin and intravenous immunoglobulin. Respiratory infection with the parainfluenza virus in immunocompromised adults, including transplant patients, is associated with significant morbidity and mortality, and early treatment with ribavirin and intravenous immunoglobulin may markedly improve their outcomes. To the best of our knowledge, this is the first case report of the successful treatment of parainfluenza infection with ribavirin and intravenous immunoglobulin in a patient with liver transplantation.