Primary herpes Simplex Virus type 1 pneumonitis in a patient after bilateral lung transplantation.

Background: Herpes Simplex Virus type 1 (HSV-1) can cause disseminated, systemic infections in immunocompromised patients. HSV-1 pneumonitis is a rare pulmonary infection that is associated with high morbidity and mortality. There is a dearth of published literature on clinical characteristics and outcomes of primary HSV-1 pneumonitis in lung transplant recipients. Clinical case: We describe case of primary HSV-1 infection in an immunocompromised patient immediately after lung transplantation. The infection resulted in fulminant pneumonitis that progressed rapidly, causing refractory hypoxia requiring prolonged mechanical ventilation and veno-venous extra-corporeal membrane oxygenation (VV-ECMO) support. The HSV-1 pneumonitis was successfully treated with antiviral therapy and supportive care, and the patient was discharged home on room air. Discussion: HSV-1 pneumonitis can be associated with fulminant course associated in immunocompromised patients with high morbidity and mortality. Prompt diagnosis and aggressive treatment is necessary for a successful outcome. In lung transplant recipients, HSV-1 pneumonitis can be associated with de novo donor specific antibodies (DSAs) and early graft loss.