What question did this study set out to answer?

To highlight human rhinovirus as a rare cause of ARDS in patients with chronic lung disease.

May 20, 2026

C48-40 ARDS: A Severe Manifestation of Rhinovirus Infection

Key Points

To highlight human rhinovirus as a rare cause of ARDS in patients with chronic lung disease.
Case presentation of a 72-year-old man with COPD and severe hypoxemia.
Imaging and bronchoscopy were utilized to assess respiratory status and identify pathogens.
Multiplex PCR confirmed the presence of rhinovirus, prompting a reassessment of treatment strategies.
Patient required intubation and mechanical ventilation due to severe hypoxemia (PaO2/FiO2 ≈ 80).
Persistent air leak and pneumothorax complicated management despite advanced ventilatory strategies.
Patient was extubated after 15 days in the ICU but ultimately needed hospice care after 73 days.

Abstract

Abstract Background Human rhinovirus (HRV) typically causes mild upper respiratory illness but has been increasingly recognized as a potential cause of severe lower respiratory tract infection and acute respiratory distress syndrome (ARDS), particularly in patients with underlying pulmonary disease. Case Presentation A 72-year-old man with COPD on home oxygen, atrial fibrillation, and obstructive sleep apnea presented with worsening dyspnea and productive cough following recent outpatient treatment for a presumed COPD exacerbation. On arrival, he was profoundly hypoxemic (SpO2 30-40%) and required BiPAP support. Imaging revealed a right-sided pneumothorax occupying more than 50% of lung volume and multilobar consolidation. Despite chest tube placement and high-flow ventilation, hypoxemia persisted (PaO2/FiO2 ≈ 80), prompting intubation, mechanical ventilation, and prone positioning. Bronchoscopy with bronchoalveolar lavage (BAL) was negative for bacterial and fungal pathogens but positive for rhinovirus by multiplex PCR. Broad-spectrum antibiotics were de-escalated after negative cultures. The patient was extubated on hospital day 15 but required noninvasive ventilation; after a prolonged 73-day ICU stay, he transitioned to hospice care. Discussion This case highlights HRV as a rare cause of ARDS in an immunocompetent host with COPD. The coexisting pneumothorax and persistent air leak complicated respiratory management, necessitating advanced ventilatory strategies. Conclusion Clinicians should maintain suspicion for viral etiologies, including HRV, in severe respiratory failure—especially among patients with chronic lung disease. Early viral testing and antibiotic stewardship are essential to optimize outcomes and minimize unnecessary antimicrobial exposure. This abstract is funded by: None

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