A lethal case of viral-bacterial pneumonia with relative lymphopenia: retrospective evaluation

Abstract

The author presents a clinical case of a fatal course of community acquired viral-bacterial pneumonia in a patient without underlying risk factors but with atypical course. Lymphopenia and neutropenia development is considered a prognostic factor for severe course and the probability of a fatal outcome. Morphology demonstrated impairment of vascular endothelial cells, hypoplasia of the lymphoid follicles in the spleen, massive necrosis of the liver parenchyma with hemorrhages. At present such case should be differentiated with pneumonia caused by mycoplasmas, legionella, rickettsias, chlamydia, pneumocystis, as well as, in the presence of epidemiological data, with influenza A (H1N1) California 2009, influenza H5N1, coronaviral infection (MERS-CoV), that is infections complicated with acute respiratory distress syndrome (ARDS). The mechanisms of neutropenia and lymphopenia development in viral lesions of the respiratory system require further inverstigation.