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Chest CT scan image. Bilateral bronchial wall thickening and ground glass opacities in a peri-bronchovascular distribution.
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A CT scan of the chest with pulmonary embolism protocol revealed no pulmonary embolism, but demonstrated bilateral bronchial wall thickening, and ground glass opacities in a peri-bronchovascular distribution (Fig. 1).
Histopathology from transbronchial biopsy. (a) Herpes virus inclusion bodies and cytopathic effect (arrows) with necrosis in bronchial wall tissue (H&E stain, 400x magnification). (b) Immunoperoxidase staining for herpes simplex virus-1 (HSV-1) (brown color) in surface bronchial epithelial cells (400x magnification).
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The biopsy specimen revealed chronic interstitial pneumonitis, squamous metaplasia and herpetic viral inclusions in bronchial epithelial cells (Fig. 2a). Immunostaining was positive for HSV-1 (Fig. 2b), and negative for respiratory syncytial virus and cytomegalovirus.