Treatment of respiratory syncytial virus with palivizumab in an adult liver transplant recipient: a case report

Background: Respiratory syncytial virus (RSV) causes upper and lower respiratory tract infections (URTIs and LRTIs) that are particularly concerning for adult immunocompromised patients. Treatment is often limited to supportive care, though there has been some success with the off-label use of palivizumab, a humanized monoclonal antibody against RSV. We report the first known case of RSV treated with palivizumab in an immunocompromised adult patient with a history of liver transplant. Case Description: A 50-year-old female with a history of orthotopic liver transplant presented with shortness of breath, cough, and acute hypoxemic respiratory failure. The respiratory panel was significant for RSV. On day 3 of admission, she required emergent intubation and was transferred to the intensive care unit. Treatment for RSV was initiated with oral ribavirin and intravenous corticosteroids. She had not clinically improved by day 6 so she was given palivizumab 700 mg (approximately 11 mg/kg) intramuscularly once. On day 8 she was extubated, and she was discharged on day 13. Conclusions: Palivizumab may be a safe and effective salvage therapy for immunocompromised patients with RSV who fail to respond to conventional treatment. Dosing and administration strategies vary throughout literature, and this report provides further evidence to support a lower-dose alternative regimen which may confer significant cost savings.