Disseminated Adenovirus Disease Presenting as Septic Shock in an Immunocompetent Pubertal Girl

Adenovirus is a common cause of respiratory illness in childhood and is associated with approximately 5% to 15% of upper and lower respiratory tract infections. Immunocompetent individuals usually have a mild and self-limited disease course, with syndromes typically including pharyngitis, bronchiolitis, keratoconjunctivitis, otitis media, and gastroenteritis. Neurologic manifestations in immunocompetent children are less common and include aseptic meningitis, myelitis, subacute focal encephalitis, seizures, paralysis, and Reye-like syndrome. Disseminated adenovirus disease is rare in immunocompetent children, occurring in approximately 1% to 1.5% of all cases of adenovirus infection compared with a 12.5% occurrence rate in immunocompromised children. Furthermore, to the best of our knowledge, disseminated adenovirus disease causing a severe sepsis-like picture in an immunocompetent child has only been described in 1 published report. Here, we present a case of a previously healthy pubertal girl who presented in severe hypotensive shock and who subsequently had adenovirus DNA detected from the cerebrospinal fluid and no other etiology identified.