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Case Reports
. 2021 Oct 26;57(11):1162.
doi: 10.3390/medicina57111162.

Tracheitis Caused by Coinfection with Cytomegalovirus and Herpes Simplex Virus

Yu-Mi Lee  1 , So-Woon Kim  2 , Won-Gun Kwack  3
Affiliations
Case Reports

Tracheitis Caused by Coinfection with Cytomegalovirus and Herpes Simplex Virus

Yu-Mi Lee et al. Medicina (Kaunas). .

Abstract

Clinically significant isolated viral tracheitis is scarce in adults, and upper airway obstruction caused by viral tracheitis is even more infrequent. A 74-year-old woman, who was administered low-dose steroids for two months for chronic obstructive pulmonary disease (COPD), developed dyspnea with stridor and required mechanical ventilation for respiratory failure. Chest computed tomography showed a diffuse tracheal wall thickening with luminal narrowing and peribronchial consolidation in the right upper lobe. Bronchoscopy revealed a proximal tracheal narrowing with multiple ulcerations of the tracheal mucosa surrounded by an erythematous margin. Pathologic examinations of the tracheal mucosal tissue, including immunohistochemistry, revealed a cytomegalovirus (CMV) and herpes simplex virus (HSV) infection. Furthermore, the bronchial alveolar lavage fluid was positive on the CMV real-time polymerase chain reaction. The patient was treated with intravenous ganciclovir for 44 days. The follow-up bronchoscopy 49 days after the initiation of ganciclovir revealed improved multiple ulcerations with scars. We report a rare case of tracheitis caused by coinfection with CMV and HSV in a patient with COPD who had been taking low-dose steroids for months. The case showed that CMV and HSV are potential causes of serious tracheitis and respiratory failure.

Keywords: cytomegalovirus; herpes simplex virus; tracheitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Neck computed tomography image. A diffuse wall thickening and intraluminal irregularity are noted in the proximal trachea (arrowhead).
Figure 2
Figure 2
Chest computed tomography images. (A, arrowhead) Aggravated diffuse wall thickening with luminal narrowing at the proximal trachea. (B) Peribronchial consolidation and secretion stasis in the right upper lobe.
Figure 3
Figure 3
Bronchoscopic images. (A) Multiple deep ulcerations are noted in the proximal trachea. (B) Multiple biopsies were performed at the ulcer base and elevated ulcer margin.
Figure 4
Figure 4
Representative images of hematoxylin and eosin and immunohistochemical staining (IHC). (A) An ulcer with granulation tissue and reactive squamous cell atypia is observed. (B) The keratinocytes present with the viral cytopathic changes of ground glass nuclei, nuclear molding, and multinucleated giant epithelial cells. IHC using the herpes simplex virus antibody was positive (inset). (C) An ulcer and granulation tissue with viral infected cells are noted (arrow), which were positive for cytomegalovirus (inset). The blue color indicates the hematoxylin counterstain. Original magnification, (A), ×40, (B,C), ×200 (Inset, IHC).
Figure 5
Figure 5
Follow-up bronchoscopic images. Improved multiple ulcerations with scars are noted in the proximal trachea.
See this image and copyright information in PMC

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