Acute respiratory distress syndrome associated with rabies: a case report.
Acute respiratory distress syndrome (ARDS) is the first potentially lethal complication in rabies virus infection, although its occurrence is rare. We report on a fatal case of rabies virus infection in a 45-year-old woman from Hu-Nan Province, China. The neurologic signs of limb numbness and water phobia occurred from 61 days after the dog bite; the clinical course was progressive, with the most severe clinical manifestations being fever, encephalitis, and ARDS. The woman expired 12 days after admission to the hospital. An autopsy proved rabies encephalitis, mainly involving the medulla oblongata, the thalamus, part of the pons, the cerebellum, and the hippocampus. The lung pathologic examination revealed the organizing phase of ARDS with diffuse alveolar damage, hyaline membrane formation, type II alveolar cell hyperplasia accompanied by proliferation of fibroblasts and infiltration of mononuclear cells into the interstitial space. Immunohistochemistry stain and reverse transcription-polymerase chain reaction for rabies virus failed to demonstrate the organism in the lung tissue. Strong expression of inducible nitric oxide synthase (iNOS) was detected in the alveolar macrophages. An immunologic mechanism with iNOS expression in the absence of direct invasion of the organism may participate in the pathogenesis of ARDS associated with rabies.
Department of Pathology, Buddhist Tzu-Chi General Hospital, 707, Section 3, Chung Yang Road, Hualien 94007, Taiwan. yhhsu@mail.tcu.edu.tw
Yung-Hsiang
YH
Hsu
Li-Chen
LC
Cho
Lih-Shinn
LS
Wang
Li-Kuang
LK
Chen
Jen-Jyh
JJ
Lee
Hui-Hua
HH
Yang
D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D009569:Nitric Oxide / Q000096:biosynthesis; D052247:Nitric Oxide Synthase Type II / Q000032:analysis; D011818:Rabies / Q000150:complications*; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D020133:Reverse Transcriptase Polymerase Chain Reaction
D009569:Nitric Oxide; D052247:Nitric Oxide Synthase Type II