Herpes simplex pneumonia: Combination therapy with oral acyclovir and aerosolized ribavirin in an immunocompetent patient.

BACKGROUND Herpes simplex viruses (HSVs) are known to cause respiratory tract infections in immunocompromised hosts and, in rare instances, in immunocompetent hosts. Numerous in vitro and in vivo studies have shown that aerosolized administration of ribavirin can potently and selectively inhibit viral replication in pulmonary disease, thereby increasing the effectiveness of acyclovir in HSV. OBJECTIVE In this case study, we reported on a 46-year-old immunocompetent woman with HSV type 1 pneumonia with bilateral pulmonary infiltrates but without mucocutaneous lesions. METHODS The diagnosis was confirmed using cytology, viral culture, and serology. Because of the persistence of fever and dyspnea, we chose an antiviral therapy. The patient received oral acyclovir and aerosolized ribavirin to improve the antiviral effectiveness of the acyclovir and to reduce the symptoms and the time to resolution of the pulmonary disease. RESULTS After 3 days of therapy, dyspnea and fever decreased and hypoxemia improved. After 2 weeks, computed tomography showed complete resolution of pulmonary abnormalities. The patient did not report any adverse effects. CONCLUSIONS In our case study, we demonstrated that therapy with a combination of aerosolized ribavirin and oral acyclovir may be useful to reduce the severity of viral infection, the adverse effects, and the days of hospitalization. To our knowledge, this is the first report in the literature of the synergistic effects of the combination of aerosolized ribavirin and oral acyclovir in the treatment of an immunocompetent patient with HSV pneumonia.