This is a 70-year-old woman with a history of hypertension and recently diagnosed with low rectal neoplasia, treated with chemotherapy ( 5-fluorouracil analogue) and preoperative radiotherapy completed 2 months before surgery.
She was admitted to the ICU after surgical intervention (amputation to nonperineal bronchoaspiration) due to suspected bronchoaspiration during anesthetic induction with oximetry repercussions and ventilatory difficulties.
Sedoanalgesia, intubation and MV were found.
Radiologically, no infiltrates indicative of parenchymal lung involvement were observed.
She had a good initial evolution, so she was extubated without incidents at 48h.
The patient presented progressive worsening in the following 2 days at the radiological level (right basal parenchymal affection), blood gas (non-invasive mechanical ventilation (NIV) was required to maintain persistent pulse oximetry with more than 90% respiratory distress.
It begins with a fever higher than 39 oC persistent, resistant to antipyretics and physical measures.
Microbiological samples were extracted (affective, urocultive and aspirated).
Antibiotic treatment started in the operating room was maintained.
Analytically, an important inflammatory reaction with C-reactive protein of 50mg/dl stands out, without accompanying leukocyte reaction (<10,000×103/μl).
Surgery and MV were maintained intubated 7 days during which fever persisted with peaks above 39oC, with radiological improvement without infiltrates and negative microbiological samples persistently. Abdominal CT was performed and a complication resulting from the removal of the mass was ruled out.
The patient was extubated with an optimal respiratory failure due to respiratory distress syndrome and good response to spontaneous breathing tests. Despite the conditions at the time of extubation, she had to be reintubated 12 hours later.
Again, she begins with high fever and repeated negative cultures, so fibrobronchoscopy with bronchoalveolar lavage (BAL) collection is performed and samples are sent to microbiology (cultive pathology and respiratory viruses for herpes, CMV).
Percutaneous herpes zoster is performed and the results of LAB are received, in which early positive PCR for HSV-1 (qualitative test) is found and, histologically, the presence of cells showing multinucleated nuclei, with
Antiviral treatment was started with methotrexate 10mg/kg/8h i.v. with clinical improvement, disappearance of fever and progressive disconnection of the respirator to full respiratory autonomy.
