RSV Pneumonia as a cause of dyspnea and hypoxia

A 43 y/o man w/ morbid obesity, OSA, diastolic heart failure and asthma presented with 3 days of worsening dyspnea on exertion, cough, subjective fevers and rhinorrhea. He had a low grade fever and hypoxia with normal lung sounds, significant LE edema and negative CXR. A JVP could not be appreciated due to body habitus. We discussed how CXR is not always sensitive for pneumonia or heart failure, and the clinical utility of BNP and d-dimer testing in this patient where the diagnosis of his dyspnea was uncertain with a wide differential including CHF, PE and pneumonia. Respiratory virus culture, (bundled in the order with rapid flu swab) returned positive for RSV consistent with RSV pneumonia, an under recognized cause of viral pneumonia in adults.

For more information, read this review article for an overview of RSV.