Palivizumab for Donor-Derived RSV Infection in an Adult Bilateral Lung Transplant Recipient: A Case Report.

Respiratory syncytial virus (RSV) causes significant morbidity in immunocompromised adults. We describe a post-operative bilateral lung transplant recipient with donor-derived RSV who developed increasing viral load and progressive respiratory failure despite conventional therapy (enteral ribavirin, methylprednisolone, IVIG) and was ultimately administered palivizumab. By day 42, the patient remained ventilator-dependent with low RSV PCR cycle threshold (Ct) values on bronchoalveolar lavage. Transbronchial biopsies showed mixed inflammatory appearances, indicating either acute RSV infection or possible rejection. Following administration of single dose intramuscular palivizumab (10 mg/kg) we observed an improving clinical trajectory and increasing Ct values. RSV became undetectable by day 64, with follow-up biopsies revealing no rejection. The patient was successfully discharged on day 87 and continues to show stable allograft function. This case demonstrates safe use of single dose palivizumab to augment conventional therapy for life-threatening RSV in the profoundly immunocompromised lung transplant recipient.