Just Simply an Upper Respiratory Infection?

We have a 30 year old woman with history of asthma, chronic pain syndrome s/p MVA  with rib resection, and history of gonorrhea and HPV presenting with 2 days of persistent cough.  With subjective fevers and chills, her concern has been coughing “fits”, as she describes it, with one to two episodes of post-tussive emesis.  Found to initially be febrile to 101.3, tachycardic and tachypneic, further evaluation revealed she had positive Respiratory Syncytial Virus (RSV) PCR sample. After a few days of observation and supportive therapy, the patient felt better and was discharged.

However, she returns a week later with her primary concern being worsening shortness of breath, pleuritic chest pain and generalized weakness. CTPA was performed revealing the absence of acute pulmonary embolism, but had chronic ground glass opacities with interval worsening of tree-in-bud opacity in the right upper lobe.  Diagnostic dilemmas ensued as to whether past history of STIs and a possibility of being immunocompromised  changes the course of clinical thinking.

Highlights of the discussion included exploring the presence and recognition of RSV in elderly and high risks individuals as internists, as it is  more commonly seen in children.  Additionally, with the standard of care being supportive therapy in adults, another point involved whether steroids plays a beneficial role in the outcome in hospitalized patients.