Human rhinovirus (HRV) is one of the most frequent
causes of respiratory tract infections (RTIs) [1]. Most HRV infections
are self-limited, but sometimes are associated with complications such
as severe lower RTIs, bacterial sinusitis and otitis media [2]. Two
4-month-old twin girls, were hospitalized with us in view of hypoxia due
to bronchiolitis. On examination, temperature was 37.7ºC, oxygen
saturation was 90%, heart and respiratory rates were 128 bpm and 60 per
min, respectively. Respiratory system examination revealed rhonchi and
chest retraction; cardiac examination was normal. White blood cell and
platelet counts were normal; hemoglobin was 9.8 g/dL with hypochromic
microcytic anemia. C-reactive protein and blood biochemistry were
normal. On chest radiography, bilateral hyperinflation was present
without evidence of consolidation. Multiplex viral PCR (Fast Track
Diagnostics/ Respiratuar Pathogen 21, Luxemburg) test from
nasopharyngeal aspirate was positive for rhinovirus in both the patient
and her twin. On fifth day, detailed cardiac examination was planned
because of insufficient improvement in hypoxia despite symptomatic
treatment. On echocardiography, 9 mm pericardial effusion (PE) was
detected on rear wall of interventricular septum with normal cardiac
function and anatomy. On repeated echocardiographies, complete
disappearance of PE was observed. Hypoxia and bronchospasm improved
within ten days, and patient was discharged after normal test results
for immune deficiencies. Recurrence was not detected on follow-ups.
In this child, PE could not be attributed to any
another cause, and was attributed to HRV infection. To the best of our
knowledge, HRV is not reported as a cause of PE. Few cases of
pericarditis associated with HRV-C besides most common causes include
Coxsackie virus, infectious mononucleosis, Adenovirus, Echo virus,
hepatitis viruses and HIV [3,4]. The limitation of diagnosis in our
patient was that we could not directly test HRV in pericardial fluid.
References
1. Jacobs SE, Lamson DM, George KS,
Walsh TJ. Human rhinoviruses. Clin Microbiol Rev. 2013;26:135-62.
2. Mandell GL, Bennett JE, Dolin R. Rhinovirus.
In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas,
and Bennett’s Principles and Practice of Infectious Diseases. 7th ed.
New York: Churchill Livingstone; 2010. p.2389-98.
3. Henquell C, Mirand A, Deusebis AL, Regagnon C,
Archimbaud C, Chambon M, et al. Prospective genotyping of human
rhinoviruses in children and adults during the winter of 2009-2010. J
Clin Virol. 2012;53:280-4.
4. Spodick DW. Pericardial diseases. In:
Braunwald E, Zipes D, Libby P, editors. Heart Disease: A Textbook of
Cardiovascular Medicine. 6th ed. Philadelphia: WB Saunders;
2001.p.1823-76.