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.