Treatment of severe adenovirus infection with HAdV-B21 in a young obese male with normal immunity

Treatment of severe adenovirus infection with HAdV-B21 in a young obese male with normal immunity | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Treatment of severe adenovirus infection with HAdV-B21 in a young obese male with normal immunity Xun Zhang, Shifeng Shao, Hong Xiao, Zhen Wang, Shili Zhong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4229160/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Adenovirus infections typically present mild to moderate symptoms in immunocompetent individuals. However, the emergence of severe adenovirus pneumonia, particularly with rare serotypes like Human Adenovirus B21 (HAdV-B21), in patients without underlying immunodeficiency challenges existing clinical paradigms and calls for novel treatment strategies. Case Presentation: We report a case of severe adenovirus infection with HAdV-B21 in a 32-year-old severely obese yellow Asian race male with normal immunity. The patient was admitted with severe respiratory distress, including fever, cough, sputum production, and dyspnea, requiring invasive mechanical ventilation. The oxygenation index was critically low at approximately 62mmHg. Traditional therapeutic interventions, including prone ventilation, hormonal anti-inflammatory therapy, and ribavirin antiviral therapy, were employed, leading to a successful outcome without needing extracorporeal membrane oxygenation (ECMO). Intervention and Outcome: The combined use of hormonal anti-inflammatory therapy and ribavirin antiviral treatment was pivotal in the patient's recovery. This approach facilitated the improvement of the patient's oxygenation index and eventual weaning from mechanical ventilation. The patient fully recovered, with adenovirus nucleic acid turning negative on the 13th day of treatment. Conclusion: This case underscores the potential for severe adenovirus pneumonia in immunocompetent adults, especially with rare serotypes like HAdV-B21. The successful recovery of our patient highlights the efficacy of a combined hormonal and antiviral treatment strategy in managing severe adenovirus infections, offering valuable insights for future clinical management. Severe adenovirus infection HAdV-B21 Immunocompetent adult Ribavirin Hormonal anti-inflammatory therapy Mechanical ventilation Figures Figure 1 Figure 2 Highlights A rare case of severe HAdV-B21 infection in an immunocompetent adult. Successful use of combined ventilation, anti-inflammatory, and antiviral therapy. Significant improvement in oxygenation index and full recovery. Negative conversion of adenovirus nucleic acid confirmed recovery. Provides insight into managing rare severe adenovirus infections. 1. Introduction Adenoviruses constitute a diverse group of pathogens capable of causing a wide array of human diseases, ranging from mild respiratory illnesses to severe, life-threatening conditions. These non-enveloped, double-stranded DNA viruses are known for their stability in the external environment, facilitating transmission and causing outbreaks in communal settings such as military barracks and healthcare facilities[ 1 ]. In immunocompetent individuals, adenovirus infections typically manifest as self-limiting conditions affecting the respiratory tract, gastrointestinal system, or conjunctiva. However, severe forms of the disease, including pneumonia, can occur, particularly in immunocompromised patients or in the context of novel or re-emergent adenovirus serotypes. The rarity of severe adenovirus infections in individuals with normal immunity makes each case significantly contribute to our understanding of the virus's pathogenic potential and clinical management[ 2 ]. The epidemiology of adenovirus infections reveals a complex landscape of more than 50 serotypes, each associated with different clinical presentations and varying degrees of severity[ 3 ]. Human Adenovirus B21 (HAdV-B21) is particularly interesting due to its uncommon occurrence and the lack of data regarding its epidemiology and clinical impact. HAdV-B21 has been sporadically reported in the literature, with cases often presenting severe symptoms and a higher risk of progression to acute respiratory distress syndrome (ARDS). This serotype's ability to cause severe disease in otherwise healthy adults highlights a critical gap in our understanding of adenovirus pathogenesis and the need for enhanced surveillance, diagnosis, and treatment strategies ( ). Existing literature predominantly focuses on common serotypes, such as types 3 and 7, leaving a knowledge void around the clinical management of rarer serotypes like HAdV-B21[ 4 ]. Current challenges in treating adenovirus infections underscore the necessity for novel therapeutic approaches and a better understanding of the virus's behavior in immunocompetent hosts. The lack of specific antiviral treatments approved for adenovirus infections necessitates a reliance on supportive care and broad-spectrum antivirals, which may not be optimally effective against all serotypes. The case of severe HAdV-B21 infection described in this report addresses this gap by illustrating the successful management of a rare and severe adenovirus infection in an immunocompetent adult. Through this case, we explore the efficacy of combined hormonal anti-inflammatory and ribavirin antiviral therapy, shedding light on potential treatment avenues for similar future cases. This contribution is poised to enrich the existing knowledge on adenovirus infections, providing valuable insights into the epidemiology, clinical presentation, and management of rare serotypes like HAdV-B21 in the general population. 2. Case report A 32-year-old yellow Asian race male with a body weight of 140 kg and no known underlying immune deficiencies presented with a 15-day history of intermittent cough and sputum production without apparent cause. Four days before hospital admission, the patient experienced a worsening of symptoms, characterized by repeated fever peaks. In response, he self-administered amoxicillin and anaxine without notable improvement. Subsequently, he sought treatment at a local clinic, where he received an unspecified antibiotic infusion. Persisting symptoms prompted a visit to a local health center, where a chest X-ray was performed, though details remain unspecified. Due to deteriorating respiratory function, the patient was administered high-flow oxygen inhalation (F 60L/min, FiO2 100%) and commenced using moxifloxacin and imipenem for anti-infection at a local hospital. Despite these measures, the patient's condition did not significantly improve, necessitating endotracheal intubation the same afternoon. Arterial blood gas analysis post-intubation revealed pH 7.26, PCO2 66.0 mmHg, PO2 62.0 mmHg, K + 4.30 mmol/L, Na + 134 mmol/L, and Lac 1.0 mmol/L. Laboratory tests indicated PCT 0.15 ng/ml, IL-6 59.91 pg/ml, and normal white blood cell count. Staining and microscopy for acid-fast bacilli, Pneumocystis carinii, nucleic acid tests for influenza A and B viruses, and novel coronavirus returned negative results. Upon transfer to our facility due to insufficient oxygenation, the patient's oxygenation index was approximately 60mmHg, indicative of severe pneumonia, type II respiratory failure, and severe acute respiratory distress syndrome (ARDS), with an APACHE II score of 21, correlating to a mortality risk of 75.68%. The patient's family declined ECMO treatment due to financial constraints. Bronchoscopic alveolar lavage revealed bilateral airway mucosal hyperemia and edema without evidence of sputum obstruction. Following lavage(Fig. 1 ), cultures and smears were obtained for further analysis. Treatment was initiated with azithromycin and moxifloxacin for anti-infection, and an intravenous injection of methylprednisolone 60mg was administered for its anti-inflammatory effects, alongside prone ventilation, low tidal volume ventilation, plateau pressure limitation, fluid rebalance, and lung re-expansion strategies. On the second day post-admission, the oxygen concentration was reduced to 50%, with an improved oxygenation index of approximately 120mmHg. A subsequent chest CT scan(Fig. 2 A-D) and adenovirus nucleic acid test confirmed a strong positive result for adenovirus with a high titer. Ribavirin therapy was initiated at a dosage of 0.5g every 12 hours. A follow-up chest CT on day 9 of treatment showed significant improvemen(Fig. 2 E-H). The methylprednisolone dosage was tapered to 30mg intravenously, and by day 10, the patient's oxygenation index had stabilized around 300mmHg, allowing for successful ventilator weaning and tracheal intubation catheter removal. By day 13, adenovirus nucleic acid tests returned negative, marking the patient's recovery and subsequent discharge. This case emphasizes the effectiveness of a multidisciplinary treatment approach, including using ribavirin and corticosteroids, in managing severe adenovirus infection, specifically HAdV-B21, in an immunocompetent adult. The intervention strategy, underscored by timely antiviral and anti-inflammatory therapies, contributed significantly to the patient's recovery, underscoring the potential for such regimens in similar cases. 3. Discussion Adenoviruses constitute a significant etiology of viral pneumonia, contributing to approximately 2% of all community-acquired pneumonia cases [ 5 – 6 ]. While predominantly observed in pediatric populations, adenovirus pneumonia can also affect healthy adults, particularly those residing or working in confined or densely populated settings, such as military environments [ 6 ]. The precise mechanisms underlying the susceptibility of immunocompetent adults to adenovirus infection remain elusive. However, it is hypothesized that environmental factors, such as suboptimal sanitary conditions observed at the patient's workplace—a construction site—may play a contributory role in the pathogenesis [ 7 ]. Notably, adenoviruses exhibit resilience against a wide array of environmental disinfectants, yet their viability can be effectively neutralized by solutions containing 95% ethanol. In cases of severe adenovirus pneumonia, the predominant symptoms include sputum production and dyspnea, with approximately 90% of patients exhibiting fever and over 90% presenting with cough. Notably, fewer than 30% of patients display neurological or gastrointestinal symptoms [ 8 ]. This case aligns with these findings, manifesting fever, cough, and sputum at disease onset, alongside white blood cell counts and procalcitonin levels within normal ranges, and a presence of lymphocytopenia, consistent with descriptions in the literature. Adenoviruses exhibit tissue tropism, with their clinical manifestations varying according to the infecting serotype. The HaV-B21 serotype, initially identified in a patient with conjunctivitis, has been linked to respiratory infections in children. However, cases of respiratory failure and severe acute respiratory distress syndrome (ARDS) associated with HaV-B21, particularly the B21a subtype, are relatively rare but have been noted for their severity and potential lethality [ 9 – 10 ]. For accurate diagnosis of adenovirus pneumonia, etiological evidence is essential. Although virus isolation and serotyping are considered the definitive standard for adenovirus diagnosis, their application in early clinical settings is limited due to the time-consuming nature of these methods. Currently, the most prevalent clinical diagnostic technique is antigen detection. This method involves analyzing patients' nasopharyngeal secretions, nasopharyngeal swabs, sputum, and bronchoalveolar lavage fluid using the immunofluorescence assay to detect the adenovirus capsid hexon antigen. Notably, the detection rate peaks 3–5 days prior to symptom onset, and in severe cases, the virus may remain detectable for over two weeks [ 11 ]. Polymerase chain reaction (PCR) assays offer a quantitative approach to viral detection. Carmen Andrea Pfortmueller highlighted in her 2019 case report the utility of quantifying viral load in alveolar lavage fluid and plasma via PCR to inform clinical management and prognosis assessment [ 12 ]. Macrogenome sequencing presents significant benefits for identifying pathogens in patients with critical infections. For infections with non-specific pathogens, early identification and subsequent targeted therapy are critical to improving patient survival rates. Currently, the management of severe adenovirus pneumonia lacks specific treatments, with care predominantly supportive. The therapeutic efficacy of pharmacological interventions remains underexplored due to the scarcity of large-scale, controlled clinical studies. Cidofovir, approved by the US FDA for treating severe adenovirus pneumonia, is not available in China, and its clinical efficacy in this context remains uncertain. A 2019 Swiss study reported the deaths from multiple organ failure of two patients with severe adenovirus pneumonia despite receiving ECMO-supported cidofovir treatment [ 12 ]. While there have been instances of successful outcomes attributed to cidofovir, discerning whether these results stem from the drug's action or other therapeutic influences remains challenging. Ribavirin, a guanosine analog with in vitro efficacy against both DNA and RNA viruses, is indicated for cytomegalovirus infections according to the Chinese pharmacopeia. Jie Gu's 2021 meta-analysis identified ribavirin as the second most frequently administered medication following cidofovir for adenovirus pneumonia (15/228, 6.6%) [ 13 ]. Byung Woo Yoon's 2017 report detailed a successful treatment of adenovirus pneumonia with oral ribavirin in a 39-year-old male [ 14 ]. Additionally, a 2022 observational study by Shen K involving 52 pediatric patients with adenovirus pneumonia found that ribavirin monotherapy significantly shortened the duration of non-respiratory symptoms [ 15 – 16 ]. In this case, the patient's oxygenation showed no significant improvement until ribavirin was administered three days post-admission, at which point a substantial enhancement in oxygenation was observed, highlighting ribavirin's potential effectiveness in this patient. In the initial phase of severe infections, both pro-inflammatory and anti-inflammatory responses are activated concurrently. The dominant response significantly influences the prognosis of critically ill patients. Glucocorticoids serve an essential anti-inflammatory function in managing severe adenovirus pneumonia by moderating the excessive immune reaction during the infection's early stages and diminishing pulmonary exudation. Concurrently, current guidelines for managing severe acute respiratory distress syndrome (ARDS) endorse the early application of glucocorticoids and immunoglobulin therapy. In the case discussed, timely administration of glucocorticoid therapy was crucial in reducing pulmonary exudation, and the adoption of a prone position proved pivotal for the obese patient to navigate through the most critical phase on the night of admission. Conclusion In conclusion, severe adenovirus pneumonia is associated with a high mortality rate, with treatment predominantly reliant on supportive measures. In scenarios lacking ECMO support, the emphasis on prone position ventilation and ARDS ventilation strategies becomes central to care, while early intervention with glucocorticoids, immunoglobulins, and antiviral therapy serves as complementary approaches. Declarations Acknowledgements Not applicable. Author contribution Xun Zhang and Shili Zhong collected all information about this case, and was the major contributor in writing the manuscript. Shifeng Shao,Hong Xiao,Zhen Wang performed all examinations and treated the patient. and Shili Zhong read the frst draft of the manuscript and made changes that contribute to the fnal version. All authors read and approved the fnal manuscript. Availability of data and material Not applicable. Funding Chongqing Medical Key Discipline Development Project Ethics approval and consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal Competing interests The authors declare no competing interests. References Lynch JP 3rd, Kajon AE. Adenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention. Semin Respir Crit Care Med. 2016 Aug;37(4):586-602.Epub 2016 Aug 3. Cillóniz C, Pericàs JM, Rojas JR, Torres A. Severe Infections Due to Respiratory Viruses. Semin Respir Crit Care Med. 2022 Feb;43(1):60-74. Epub 2022 Feb 16. Scott MK, Chommanard C, Lu X, Appelgate D, Grenz L, Schneider E, et al. Human adenovirus associated with severe respiratory infection, Oregon, USA, 2013-2014.Emerg Infect Dis 2016;22(6):1044–51. Biserni GB, Scarpini S, Dondi A, Biagi C, Pierantoni L, Masetti R, Sureshkumar S, Rocca A, Lanari M. Potential Diagnostic and Prognostic Biomarkers for Adenovirus Respiratory Infection in Children and Young Adults. Viruses. 2021 Sep 21;13(9):1885. Saint-Pierre Contreras G, Conei Valencia D, Lizama L, Vargas Zuñiga D, Avendaño Carvajal LF, Ampuero Llanos S. An Old Acquaintance: Could Adenoviruses Be Our Next Pandemic Threat? Viruses. 2023 Jan 24;15(2):330. Kim D, Lee E, Eom J, Kim Y, Kwon SH, Oh HS, Huh K, Park H, Jung J, Park B. Prevalence and Burden of Human Adenovirus-Associated Acute Respiratory Illness in the Republic of Korea Military, 2013 to 2022. J Korean Med Sci. 2024 Jan 29;39(4):e38. Radke JR, Cook JL. Human adenovirus lung disease: outbreaks, models of immune-response-driven acute lung injury and pandemic potential. Curr Opin Infect Dis. 2023 Jun 1;36(3):164-170. Epub 2023 Apr 6. Lion, T. Adenovirus persistence, reactivation, and clinical management. FEBS Lett. 2019, 593, 3571–3582. Sammons JS, Graf EH, Townsend S, Hoegg CL, Smathers SA, Coffin SE, Williams K, Mitchell SL, Nawab U, Munson D, Quinn G, Binenbaum G. Outbreak of Adenovirus in a Neonatal Intensive Care Unit: Critical Importance of Equipment Cleaning During Inpatient Ophthalmologic Examinations. Ophthalmology. 2019 Jan;126(1):137-143.2018.07.008. Epub 2018 Sep 1. Gray GC, McCarthy T, Lebeck MG, Schnurr DP, Russell KL, Kajon AE, Landry ML, Leland DS, Storch GA, Ginocchio CC, Robinson CC, Demmler GJ, Saubolle MA, Kehl SC, Selvarangan R, Miller MB, Chappell JD, Zerr DM, Kiska DL, Halstead DC, Capuano AW, Setterquist SF, Chorazy ML, Dawson JD, Erdman DD. Genotype prevalence and risk factors for severe clinical adenovirus infection, United States 2004-2006. Clin Infect Dis. 2007 Nov 1;45(9):1120-31. Epub 2007 Sep 27. Morozumi M, Shimizu H, Matsushima Y, Mitamura K, Tajima T, Iwata S, Ubukata K. Evaluation of new immunochromatographic assay kit for adenovirus detection in throat swab: comparison with culture and real-time PCR results. J Infect Chemother. 2014 May;20(5):303-6. Epub 2014 Mar 1. Huang HS, Tsai CL, Chang J, Hsu TC, Lin S, Lee CC. Multiplex PCR system for the rapid diagnosis of respiratory virus infection: systematic review and meta-analysis. Clin Microbiol Infect. 2018 Oct;24(10):1055-1063. Pfortmueller CA, Barbani MT, Schefold JC, Hage E, Heim A, Zimmerli S. Severe acute respiratory distress syndrome (ARDS) induced by human adenovirus B21: Report on 2 cases and literature review. J Crit Care. 2019 Jun;51:99-104.Epub 2019 Feb 13. Gu J, Su QQ, Zuo TT, Chen YB. Adenovirus diseases: a systematic review and meta-analysis of 228 case reports. Infection. 2021 Feb;49(1):1-13. Epub 2020 Jul 27. Yoon BW, Song YG, Lee SH. Severe community-acquired adenovirus pneumonia treated with oral ribavirin: a case report. BMC Res Notes. 2017 Jan 18;10(1):47. Shen K, Wang Y, Li P, Su X. Clinical features, treatment and outcomes of an outbreak of type 7 adenovirus pneumonia in centralized residence young adults. J Clin Virol. 2022 Sep;154:105244. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4229160","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":290276248,"identity":"995d82f2-371c-4c44-8965-398c91d41cad","order_by":0,"name":"Xun Zhang","email":"","orcid":"","institution":"Army Medical Center of PLA","correspondingAuthor":false,"prefix":"","firstName":"Xun","middleName":"","lastName":"Zhang","suffix":""},{"id":290276249,"identity":"696924e3-032f-4664-a3ba-e41237f31589","order_by":1,"name":"Shifeng Shao","email":"","orcid":"","institution":"Army Medical Center of PLA","correspondingAuthor":false,"prefix":"","firstName":"Shifeng","middleName":"","lastName":"Shao","suffix":""},{"id":290276250,"identity":"841a8797-5a96-4a43-bb7a-5b17fed6bda6","order_by":2,"name":"Hong Xiao","email":"","orcid":"","institution":"Army Medical Center of PLA","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Xiao","suffix":""},{"id":290276251,"identity":"0d262686-fc35-444b-b9b1-0db17dbd33ef","order_by":3,"name":"Zhen Wang","email":"","orcid":"","institution":"Army Medical Center of PLA","correspondingAuthor":false,"prefix":"","firstName":"Zhen","middleName":"","lastName":"Wang","suffix":""},{"id":290276252,"identity":"aa9ecf10-8fdb-48d0-a677-1095149338c2","order_by":4,"name":"Shili Zhong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBACfmb+hw8kKv7V97M3EKlFsr2H2cDizAHGmT0HiNRicOYMm0BlywHGDTcSiLVlRu4xhpsNd5glZz7eeIOhxiaaoBZ+iby0hzN3PGPjl04rtmA4lpbbQNiWBHNjyTPMPJKzc8wkGBsOE9ZicCPBTPpvG7OEwc0zxGo5A1Qp2XbYwOAGD5FaJNvbkg0kzqQlSPYA/ZJAjF/4mZkPAqPSJoGf/fDGGx9qbAhrQXGkRAIpyiFaSNUxCkbBKBgFIwMAAI2qRJztNrV+AAAAAElFTkSuQmCC","orcid":"","institution":"Army Medical Center of PLA","correspondingAuthor":true,"prefix":"","firstName":"Shili","middleName":"","lastName":"Zhong","suffix":""}],"badges":[],"createdAt":"2024-04-07 02:14:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4229160/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4229160/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54785310,"identity":"94fb7892-a263-468f-aea3-c12163357ccf","added_by":"auto","created_at":"2024-04-16 18:10:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":432822,"visible":true,"origin":"","legend":"\u003cp\u003eAirway condition under fiberbronchoscopy on the first day of admission\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4229160/v1/919222e70dc8c019c952d759.png"},{"id":54785311,"identity":"816723df-0ae1-4676-886e-05c248472e1e","added_by":"auto","created_at":"2024-04-16 18:10:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":3720864,"visible":true,"origin":"","legend":"\u003cp\u003eChest CT on day 1(A-D) and day 9 of admission(E-H)\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4229160/v1/f88fb7a3d1f115925721952d.png"},{"id":79570676,"identity":"29b18802-b587-4152-b3c4-464eadc8d9ab","added_by":"auto","created_at":"2025-03-31 10:31:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6147905,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4229160/v1/998dd37a-3445-4921-aeb9-7e82b15dee9c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Treatment of severe adenovirus infection with HAdV-B21 in a young obese male with normal immunity","fulltext":[{"header":"Highlights","content":"\u003cul start=\"12\"\u003e\n \u003cli\u003eA rare case of severe HAdV-B21 infection in an immunocompetent adult.\u003c/li\u003e\n \u003cli\u003eSuccessful use of combined ventilation, anti-inflammatory, and antiviral therapy.\u003c/li\u003e\n \u003cli\u003eSignificant improvement in oxygenation index and full recovery.\u003c/li\u003e\n \u003cli\u003eNegative conversion of adenovirus nucleic acid confirmed recovery.\u003c/li\u003e\n \u003cli\u003eProvides insight into managing rare severe adenovirus infections.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"1. Introduction","content":"\u003cp\u003eAdenoviruses constitute a diverse group of pathogens capable of causing a wide array of human diseases, ranging from mild respiratory illnesses to severe, life-threatening conditions. These non-enveloped, double-stranded DNA viruses are known for their stability in the external environment, facilitating transmission and causing outbreaks in communal settings such as military barracks and healthcare facilities[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In immunocompetent individuals, adenovirus infections typically manifest as self-limiting conditions affecting the respiratory tract, gastrointestinal system, or conjunctiva. However, severe forms of the disease, including pneumonia, can occur, particularly in immunocompromised patients or in the context of novel or re-emergent adenovirus serotypes. The rarity of severe adenovirus infections in individuals with normal immunity makes each case significantly contribute to our understanding of the virus's pathogenic potential and clinical management[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe epidemiology of adenovirus infections reveals a complex landscape of more than 50 serotypes, each associated with different clinical presentations and varying degrees of severity[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Human Adenovirus B21 (HAdV-B21) is particularly interesting due to its uncommon occurrence and the lack of data regarding its epidemiology and clinical impact. HAdV-B21 has been sporadically reported in the literature, with cases often presenting severe symptoms and a higher risk of progression to acute respiratory distress syndrome (ARDS). This serotype's ability to cause severe disease in otherwise healthy adults highlights a critical gap in our understanding of adenovirus pathogenesis and the need for enhanced surveillance, diagnosis, and treatment strategies ( ). Existing literature predominantly focuses on common serotypes, such as types 3 and 7, leaving a knowledge void around the clinical management of rarer serotypes like HAdV-B21[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrent challenges in treating adenovirus infections underscore the necessity for novel therapeutic approaches and a better understanding of the virus's behavior in immunocompetent hosts. The lack of specific antiviral treatments approved for adenovirus infections necessitates a reliance on supportive care and broad-spectrum antivirals, which may not be optimally effective against all serotypes. The case of severe HAdV-B21 infection described in this report addresses this gap by illustrating the successful management of a rare and severe adenovirus infection in an immunocompetent adult. Through this case, we explore the efficacy of combined hormonal anti-inflammatory and ribavirin antiviral therapy, shedding light on potential treatment avenues for similar future cases. This contribution is poised to enrich the existing knowledge on adenovirus infections, providing valuable insights into the epidemiology, clinical presentation, and management of rare serotypes like HAdV-B21 in the general population.\u003c/p\u003e"},{"header":"2. Case report","content":"\u003cp\u003eA 32-year-old yellow Asian race male with a body weight of 140 kg and no known underlying immune deficiencies presented with a 15-day history of intermittent cough and sputum production without apparent cause. Four days before hospital admission, the patient experienced a worsening of symptoms, characterized by repeated fever peaks. In response, he self-administered amoxicillin and anaxine without notable improvement. Subsequently, he sought treatment at a local clinic, where he received an unspecified antibiotic infusion. Persisting symptoms prompted a visit to a local health center, where a chest X-ray was performed, though details remain unspecified. Due to deteriorating respiratory function, the patient was administered high-flow oxygen inhalation (F 60L/min, FiO2 100%) and commenced using moxifloxacin and imipenem for anti-infection at a local hospital. Despite these measures, the patient's condition did not significantly improve, necessitating endotracheal intubation the same afternoon. Arterial blood gas analysis post-intubation revealed pH 7.26, PCO2 66.0 mmHg, PO2 62.0 mmHg, K\u0026thinsp;+\u0026thinsp;4.30 mmol/L, Na\u0026thinsp;+\u0026thinsp;134 mmol/L, and Lac 1.0 mmol/L. Laboratory tests indicated PCT 0.15 ng/ml, IL-6 59.91 pg/ml, and normal white blood cell count. Staining and microscopy for acid-fast bacilli, Pneumocystis carinii, nucleic acid tests for influenza A and B viruses, and novel coronavirus returned negative results.\u003c/p\u003e \u003cp\u003eUpon transfer to our facility due to insufficient oxygenation, the patient's oxygenation index was approximately 60mmHg, indicative of severe pneumonia, type II respiratory failure, and severe acute respiratory distress syndrome (ARDS), with an APACHE II score of 21, correlating to a mortality risk of 75.68%. The patient's family declined ECMO treatment due to financial constraints. Bronchoscopic alveolar lavage revealed bilateral airway mucosal hyperemia and edema without evidence of sputum obstruction. Following lavage(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), cultures and smears were obtained for further analysis. Treatment was initiated with azithromycin and moxifloxacin for anti-infection, and an intravenous injection of methylprednisolone 60mg was administered for its anti-inflammatory effects, alongside prone ventilation, low tidal volume ventilation, plateau pressure limitation, fluid rebalance, and lung re-expansion strategies.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOn the second day post-admission, the oxygen concentration was reduced to 50%, with an improved oxygenation index of approximately 120mmHg. A subsequent chest CT scan(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA-D) and adenovirus nucleic acid test confirmed a strong positive result for adenovirus with a high titer. Ribavirin therapy was initiated at a dosage of 0.5g every 12 hours. A follow-up chest CT on day 9 of treatment showed significant improvemen(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eE-H). The methylprednisolone dosage was tapered to 30mg intravenously, and by day 10, the patient's oxygenation index had stabilized around 300mmHg, allowing for successful ventilator weaning and tracheal intubation catheter removal. By day 13, adenovirus nucleic acid tests returned negative, marking the patient's recovery and subsequent discharge.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThis case emphasizes the effectiveness of a multidisciplinary treatment approach, including using ribavirin and corticosteroids, in managing severe adenovirus infection, specifically HAdV-B21, in an immunocompetent adult. The intervention strategy, underscored by timely antiviral and anti-inflammatory therapies, contributed significantly to the patient's recovery, underscoring the potential for such regimens in similar cases.\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eAdenoviruses constitute a significant etiology of viral pneumonia, contributing to approximately 2% of all community-acquired pneumonia cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. While predominantly observed in pediatric populations, adenovirus pneumonia can also affect healthy adults, particularly those residing or working in confined or densely populated settings, such as military environments [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The precise mechanisms underlying the susceptibility of immunocompetent adults to adenovirus infection remain elusive. However, it is hypothesized that environmental factors, such as suboptimal sanitary conditions observed at the patient's workplace—a construction site—may play a contributory role in the pathogenesis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Notably, adenoviruses exhibit resilience against a wide array of environmental disinfectants, yet their viability can be effectively neutralized by solutions containing 95% ethanol.\u003c/p\u003e \u003cp\u003eIn cases of severe adenovirus pneumonia, the predominant symptoms include sputum production and dyspnea, with approximately 90% of patients exhibiting fever and over 90% presenting with cough. Notably, fewer than 30% of patients display neurological or gastrointestinal symptoms [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This case aligns with these findings, manifesting fever, cough, and sputum at disease onset, alongside white blood cell counts and procalcitonin levels within normal ranges, and a presence of lymphocytopenia, consistent with descriptions in the literature. Adenoviruses exhibit tissue tropism, with their clinical manifestations varying according to the infecting serotype. The HaV-B21 serotype, initially identified in a patient with conjunctivitis, has been linked to respiratory infections in children. However, cases of respiratory failure and severe acute respiratory distress syndrome (ARDS) associated with HaV-B21, particularly the B21a subtype, are relatively rare but have been noted for their severity and potential lethality [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e–\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor accurate diagnosis of adenovirus pneumonia, etiological evidence is essential. Although virus isolation and serotyping are considered the definitive standard for adenovirus diagnosis, their application in early clinical settings is limited due to the time-consuming nature of these methods. Currently, the most prevalent clinical diagnostic technique is antigen detection. This method involves analyzing patients' nasopharyngeal secretions, nasopharyngeal swabs, sputum, and bronchoalveolar lavage fluid using the immunofluorescence assay to detect the adenovirus capsid hexon antigen. Notably, the detection rate peaks 3–5 days prior to symptom onset, and in severe cases, the virus may remain detectable for over two weeks [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Polymerase chain reaction (PCR) assays offer a quantitative approach to viral detection. Carmen Andrea Pfortmueller highlighted in her 2019 case report the utility of quantifying viral load in alveolar lavage fluid and plasma via PCR to inform clinical management and prognosis assessment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Macrogenome sequencing presents significant benefits for identifying pathogens in patients with critical infections. For infections with non-specific pathogens, early identification and subsequent targeted therapy are critical to improving patient survival rates.\u003c/p\u003e \u003cp\u003eCurrently, the management of severe adenovirus pneumonia lacks specific treatments, with care predominantly supportive. The therapeutic efficacy of pharmacological interventions remains underexplored due to the scarcity of large-scale, controlled clinical studies. Cidofovir, approved by the US FDA for treating severe adenovirus pneumonia, is not available in China, and its clinical efficacy in this context remains uncertain. A 2019 Swiss study reported the deaths from multiple organ failure of two patients with severe adenovirus pneumonia despite receiving ECMO-supported cidofovir treatment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. While there have been instances of successful outcomes attributed to cidofovir, discerning whether these results stem from the drug's action or other therapeutic influences remains challenging. Ribavirin, a guanosine analog with in vitro efficacy against both DNA and RNA viruses, is indicated for cytomegalovirus infections according to the Chinese pharmacopeia. Jie Gu's 2021 meta-analysis identified ribavirin as the second most frequently administered medication following cidofovir for adenovirus pneumonia (15/228, 6.6%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Byung Woo Yoon's 2017 report detailed a successful treatment of adenovirus pneumonia with oral ribavirin in a 39-year-old male [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Additionally, a 2022 observational study by Shen K involving 52 pediatric patients with adenovirus pneumonia found that ribavirin monotherapy significantly shortened the duration of non-respiratory symptoms [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e–\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In this case, the patient's oxygenation showed no significant improvement until ribavirin was administered three days post-admission, at which point a substantial enhancement in oxygenation was observed, highlighting ribavirin's potential effectiveness in this patient.\u003c/p\u003e \u003cp\u003eIn the initial phase of severe infections, both pro-inflammatory and anti-inflammatory responses are activated concurrently. The dominant response significantly influences the prognosis of critically ill patients. Glucocorticoids serve an essential anti-inflammatory function in managing severe adenovirus pneumonia by moderating the excessive immune reaction during the infection's early stages and diminishing pulmonary exudation. Concurrently, current guidelines for managing severe acute respiratory distress syndrome (ARDS) endorse the early application of glucocorticoids and immunoglobulin therapy. In the case discussed, timely administration of glucocorticoid therapy was crucial in reducing pulmonary exudation, and the adoption of a prone position proved pivotal for the obese patient to navigate through the most critical phase on the night of admission.\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, severe adenovirus pneumonia is associated with a high mortality rate, with treatment predominantly reliant on supportive measures. In scenarios lacking ECMO support, the emphasis on prone position ventilation and ARDS ventilation strategies becomes central to care, while early intervention with glucocorticoids, immunoglobulins, and antiviral therapy serves as complementary approaches.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthor contribution\u003c/strong\u003e Xun Zhang and Shili Zhong collected all information about this case, and was the major contributor in writing the manuscript. Shifeng Shao,Hong Xiao,Zhen Wang performed all examinations and treated the patient. and Shili Zhong read the frst draft of the manuscript and made changes that contribute to the fnal version. All authors read and approved the fnal manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAvailability\u0026nbsp;of data\u0026nbsp;and material\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eChongqing Medical Key Discipline Development Project\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics approval and consent\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The authors declare no competing interests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLynch JP 3rd, Kajon AE. Adenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention. Semin Respir Crit Care Med. 2016 Aug;37(4):586-602.Epub 2016 Aug 3. \u003c/li\u003e\n\u003cli\u003eCill\u0026oacute;niz C, Peric\u0026agrave;s JM, Rojas JR, Torres A. Severe Infections Due to Respiratory Viruses. Semin Respir Crit Care Med. 2022 Feb;43(1):60-74. Epub 2022 Feb 16. \u003c/li\u003e\n\u003cli\u003eScott MK, Chommanard C, Lu X, Appelgate D, Grenz L, Schneider E, et al. Human adenovirus associated with severe respiratory infection, Oregon, USA, 2013-2014.Emerg Infect Dis 2016;22(6):1044\u0026ndash;51.\u003c/li\u003e\n\u003cli\u003eBiserni GB, Scarpini S, Dondi A, Biagi C, Pierantoni L, Masetti R, Sureshkumar S, Rocca A, Lanari M. Potential Diagnostic and Prognostic Biomarkers for Adenovirus Respiratory Infection in Children and Young Adults. Viruses. 2021 Sep 21;13(9):1885. \u003c/li\u003e\n\u003cli\u003eSaint-Pierre Contreras G, Conei Valencia D, Lizama L, Vargas Zu\u0026ntilde;iga D, Avenda\u0026ntilde;o Carvajal LF, Ampuero Llanos S. An Old Acquaintance: Could Adenoviruses Be Our Next Pandemic Threat? Viruses. 2023 Jan 24;15(2):330. \u003c/li\u003e\n\u003cli\u003eKim D, Lee E, Eom J, Kim Y, Kwon SH, Oh HS, Huh K, Park H, Jung J, Park B. Prevalence and Burden of Human Adenovirus-Associated Acute Respiratory Illness in the Republic of Korea Military, 2013 to 2022. J Korean Med Sci. 2024 Jan 29;39(4):e38. \u003c/li\u003e\n\u003cli\u003eRadke JR, Cook JL. Human adenovirus lung disease: outbreaks, models of immune-response-driven acute lung injury and pandemic potential. Curr Opin Infect Dis. 2023 Jun 1;36(3):164-170. Epub 2023 Apr 6.\u003c/li\u003e\n\u003cli\u003eLion, T. Adenovirus persistence, reactivation, and clinical management. FEBS Lett. 2019, 593, 3571\u0026ndash;3582.\u003c/li\u003e\n\u003cli\u003eSammons JS, Graf EH, Townsend S, Hoegg CL, Smathers SA, Coffin SE, Williams K, Mitchell SL, Nawab U, Munson D, Quinn G, Binenbaum G. Outbreak of Adenovirus in a Neonatal Intensive Care Unit: Critical Importance of Equipment Cleaning During Inpatient Ophthalmologic Examinations. Ophthalmology. 2019 Jan;126(1):137-143.2018.07.008. Epub 2018 Sep 1. \u003c/li\u003e\n\u003cli\u003eGray GC, McCarthy T, Lebeck MG, Schnurr DP, Russell KL, Kajon AE, Landry ML, Leland DS, Storch GA, Ginocchio CC, Robinson CC, Demmler GJ, Saubolle MA, Kehl SC, Selvarangan R, Miller MB, Chappell JD, Zerr DM, Kiska DL, Halstead DC, Capuano AW, Setterquist SF, Chorazy ML, Dawson JD, Erdman DD. Genotype prevalence and risk factors for severe clinical adenovirus infection, United States 2004-2006. Clin Infect Dis. 2007 Nov 1;45(9):1120-31. Epub 2007 Sep 27.\u003c/li\u003e\n\u003cli\u003eMorozumi M, Shimizu H, Matsushima Y, Mitamura K, Tajima T, Iwata S, Ubukata K. Evaluation of new immunochromatographic assay kit for adenovirus detection in throat swab: comparison with culture and real-time PCR results. J Infect Chemother. 2014 May;20(5):303-6. Epub 2014 Mar 1. \u003c/li\u003e\n\u003cli\u003eHuang HS, Tsai CL, Chang J, Hsu TC, Lin S, Lee CC. Multiplex PCR system for the rapid diagnosis of respiratory virus infection: systematic review and meta-analysis. Clin Microbiol Infect. 2018 Oct;24(10):1055-1063. \u003c/li\u003e\n\u003cli\u003ePfortmueller CA, Barbani MT, Schefold JC, Hage E, Heim A, Zimmerli S. Severe acute respiratory distress syndrome (ARDS) induced by human adenovirus B21: Report on 2 cases and literature review. J Crit Care. 2019 Jun;51:99-104.Epub 2019 Feb 13. \u003c/li\u003e\n\u003cli\u003eGu J, Su QQ, Zuo TT, Chen YB. Adenovirus diseases: a systematic review and meta-analysis of 228 case reports. Infection. 2021 Feb;49(1):1-13. Epub 2020 Jul 27. \u003c/li\u003e\n\u003cli\u003eYoon BW, Song YG, Lee SH. Severe community-acquired adenovirus pneumonia treated with oral ribavirin: a case report. BMC Res Notes. 2017 Jan 18;10(1):47.\u003c/li\u003e\n\u003cli\u003eShen K, Wang Y, Li P, Su X. Clinical features, treatment and outcomes of an outbreak of type 7 adenovirus pneumonia in centralized residence young adults. J Clin Virol. 2022 Sep;154:105244.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Severe adenovirus infection, HAdV-B21, Immunocompetent adult, Ribavirin, Hormonal anti-inflammatory therapy, Mechanical ventilation","lastPublishedDoi":"10.21203/rs.3.rs-4229160/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4229160/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAdenovirus infections typically present mild to moderate symptoms in immunocompetent individuals. However, the emergence of severe adenovirus pneumonia, particularly with rare serotypes like Human Adenovirus B21 (HAdV-B21), in patients without underlying immunodeficiency challenges existing clinical paradigms and calls for novel treatment strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation: \u003c/strong\u003eWe report a case of severe adenovirus infection with HAdV-B21 in a 32-year-old severely obese yellow Asian race male with normal immunity. The patient was admitted with severe respiratory distress, including fever, cough, sputum production, and dyspnea, requiring invasive mechanical ventilation. The oxygenation index was critically low at approximately 62mmHg. Traditional therapeutic interventions, including prone ventilation, hormonal anti-inflammatory therapy, and ribavirin antiviral therapy, were employed, leading to a successful outcome without needing extracorporeal membrane oxygenation (ECMO).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention and Outcome: \u003c/strong\u003eThe combined use of hormonal anti-inflammatory therapy and ribavirin antiviral treatment was pivotal in the patient's recovery. This approach facilitated the improvement of the patient's oxygenation index and eventual weaning from mechanical ventilation. The patient fully recovered, with adenovirus nucleic acid turning negative on the 13th day of treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis case underscores the potential for severe adenovirus pneumonia in immunocompetent adults, especially with rare serotypes like HAdV-B21. The successful recovery of our patient highlights the efficacy of a combined hormonal and antiviral treatment strategy in managing severe adenovirus infections, offering valuable insights for future clinical management.\u003c/p\u003e","manuscriptTitle":"Treatment of severe adenovirus infection with HAdV-B21 in a young obese male with normal immunity","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-16 18:10:19","doi":"10.21203/rs.3.rs-4229160/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"992109d1-98c3-4e3c-86dc-730fa2db7c88","owner":[],"postedDate":"April 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-31T10:23:38+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-16 18:10:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4229160","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4229160","identity":"rs-4229160","version":["v1"]},"buildId":"J0_U0BvcaRcwD8yVFaRlm","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}