{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:04:28Z","timestamp":1789362268473,"version":"build-2803163510"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Herpes simplex virus type 1 (HSV-1) is a ubiquitous pathogen. Nevertheless, disseminated HSV-1 infection with confirmed viremia and fatal acute respiratory distress syndrome (ARDS) following intestinal obstruction in very old individuals is exceedingly rare. Here we report a 91-year-old patient with previously intact immunity who developed ARDS after incomplete intestinal obstruction, followed by HSV-1 reactivation. Although routine microbiological tests remained negative, five consecutive metagenomic next-generation sequencing (mNGS) assays dynamically tracked the evolving pathogens throughout the disease course. Despite broad-spectrum antibiotics, antifungals, antivirals, corticosteroids, IVIG, and mechanical ventilation, the patient\u2019s refractory hypoxemia remained uncorrected, leading to multiple organ dysfunction and death. This case highlights a rare clinical scenario and provides valuable insights for the diagnosis and management of critically ill elderly patients, offering a comprehensive, longitudinal perspective on the clinical application of mNGS.<\/jats:p>","DOI":"10.3389\/fmed.2026.1910309","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T04:34:05Z","timestamp":1789360445000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Sequential mNGS captures fatal HSV-1 reactivation after intestinal obstruction-associated ARDS in a 91-year-old"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiahuan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Cadre Ward Two, Central Theater Command General Hospital of the PLA","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cadre Ward Two, Central Theater Command General Hospital of the PLA","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huafang","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Cadre Ward Two, Central Theater Command General Hospital of the PLA","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cadre Ward Two, Central Theater Command General Hospital of the PLA","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Cadre Ward Two, Central Theater Command General Hospital of the PLA","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1624907","DOI":"10.3389\/fmed.2025.1624907","article-title":"The intricate interactions between the lungs and gut in patients: unraveling the crosstalk mechanism.","volume":"12","author":"Li","year":"2025","journal-title":"Front Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e19995","DOI":"10.7717\/peerj.19995","article-title":"A mini review of the relationship between intestinal microecology and acute respiratory distress syndrome.","volume":"13","author":"Chen","year":"2025","journal-title":"Peerj."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1693964","DOI":"10.3389\/fimmu.2025.1693964","article-title":"The gut-lung axis: effects and mechanisms of gut microbiota on pulmonary diseases.","volume":"16","author":"Liu","year":"2026","journal-title":"Front Immunol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s12931-026-03525-5","article-title":"Gut microbiota and metabolites in acute lung injury: mechanisms and therapeutic perspectives.","volume":"27","author":"Yi","year":"2026","journal-title":"Respir Res"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1007\/s00134-024-07562-w","article-title":"Herpes simplex virus and cytomegalovirus lung reactivations in severe covid-19 patients: to treat or not to treat? 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