Illustrative CasesHerpes Simplex Virus Pneumonia in an Immunocompetent Child on Corticosteroids for Acute WheezingPines, Naama MD∗; Tsabari, Reuven MD†; Kerem, Eitan MD†; Reiter, Joel MD†Author Information From the ∗Department of Pediatrics †Pediatric Pulmonary and Sleep Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Disclosure: The authors declare no conflict of interest. Reprints: Joel Reiter, MD, Pediatric Pulmonology and Sleep Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, Jerusalem 91120, Israel (e-mail: [email protected]). Pediatric Emergency Care: December 2020 - Volume 36 - Issue 12 - p e735-e736 doi: 10.1097/PEC.0000000000001519 Buy Metrics Abstract Herpes simplex virus (HSV) is rarely the cause of pneumonia in immunocompetent patients. We describe a previously healthy child, with no evidence of an immunodeficiency, who presented to the emergency department with severe pneumonia, wheezing, and pleural effusions with a history of orolabial HSV infection. On admission, he was started on antibiotics and systemic corticosteroids but continued to deteriorate. Oral lesions, blood, and pleural fluid tested positive for HSV, and improvement was achieved only after the addition of acyclovir and discontinuation of steroids. We suggest that steroids should be used with caution in patients presenting with lower respiratory tract symptoms and herpetic oral lesions. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.