An Unusual Presentation of Human Metapneumovirus Infection
Tess Chamakkala, DO
Internal Medicine Resident, St. Luke’s University Hospital, Bethlehem, Pennsylvania
Manish Kumar, MD
Pediatrics Resident, Maimonides Children’s Hospital, Brooklyn, New York
Kamal Singh, MD
Chief of Pediatrics, Peconic Bay Medical Center, Riverhead, New York, and Assistant Professor of Pediatrics, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
Sandeep A. Gandhi, MD
Infectious Diseases Consultant at Peconic Bay Medical Center, Riverhead, New York, and Associate Professor of Clinical Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
Chamakkala T, Kumar M, Singh K, Gandhi SA. An unusual presentation of human metapneumovirus infection. Consultant. 2020;60(1):29-30. doi:10.25270/con.2020.01.00008
A 15-month-old boy presented to the emergency department with multiple episodes of vomiting and a subjective fever for 2 days. His mother denied rhinorrhea or a cough in the child. The patient had no medical history. At presentation, his rectal temperature was 38°C, and his pulse was 145 beats/min. He was found to be mildly dehydrated and was admitted to the hospital.
Hospital course. On the day of admission, his temperature rose to 39.8°C, and he developed wheezing and coughing. An albuterol nebulizer provided some relief. On the second day of admission, his temperature rose to 40.3°C, and yellow diarrhea and intractable vomiting developed. He received a diagnosis of dehydration and viral gastroenteritis and was treated supportively with 5% dextrose in 0.33% normal saline and acetaminophen. On the third day, he was afebrile and began to tolerate breast milk and a regular diet. After a 4-day stay, the patient’s condition improved, and he was discharged home.
Laboratory tests. Results of a complete blood cell count showed a white blood cell count of 11,900/µL and a hemoglobin level of 11.0 g/dL. The lymphocyte count was elevated at 4300/µL, and the monocyte count was elevated at 1100/µL. Results of a rapid influenza antigen nasal swab test were negative. Chest radiography showed hyperinflated lungs and peribronchial cuffing (Figure). Blood culture results and urine culture results were normal. Urinalysis results were within normal limits, except for a ketone level of 40 mg/dL. Results of a rapid respiratory pathogen panel using polymerase chain reaction were positive for human metapneumovirus (HMPV) but negative for adenovirus, coronavirus, human enterovirus/rhinovirus, influenza, parainfluenza, and respiratory syncytial virus (RSV).
Figure. Chest radiograph showing hyperinflated lungs and peribronchial cuffing.