Severe Influenza A Virus Infection

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Severe influenza A virus infection
Case Timeline

Case of severe influenza A virus infection complicated by myositis, refractory rhabdomylosis and compartment syndrome.

This article describes the case of a 35-year-old woman with severe influenza A virus infection complicated by myositis; a rare and morbid complication of influenza infection, refractory rhabdomylosis and compartment syndrome. The patient presented to the community clinic in late March with complaints of cough, myalgias, vomiting and nausea. Doctors diagnosed her with influenza A virus.

She had refused getting the influenza vaccine earlier in the season. Treatment included ostelamivir for 5 days. On the final day of treatment, the patient presented to the emergency with an intolerability to tolerate liquids and solids. Laboratory results showed leukocytosis, hyponatremia, metabolic acidosis and elevated levels of creatinine. Liver function, lipase and creatinine kinase were all normal. Computed tomography of the abdomen showed gallbladder wall thickening and pericholestatic fluid. In addition, the patient was positive for influenza A virus. Treatment with ostelamivir was continued in addition to empiric antibiotics (ceftriaxone, and metronidazole) for presumed cholecystitis. The patient developed refractory hypertension on her 2nd day at the hospital and progressed to hypoxemic respiratory failure; she had to be mechanically ventilated.

Treatment

Doctors broadened the antibiotics to intravenous antibiotics, vancomycin and piperacillin-tazobactam. She was also empirically treated for Clostridium difficile colitis because of profound leukocytosis with oral vancomycin and intravenous metronidazole. She was also put on stress dose steroids for refractory shock. Similarly, there was no sign of growth in blood cultures. CT findings were consistent with cholecystitis and percutaneous cholecystostomy was performed.

The patient also developed hyperkalemia and worsening acidosis. She was transferred for emergent renal therapy. Examination was remarkable of tight, mottled bilateral lower extremities with no pulses and discolouration in the left upper extremity. Her creatine kinase was elevated. Conservative treatment didn’t show any improvement, therefore, doctors recommended bilateral forearm fasciotomies.

Her family, however, opted for withdrawal from aggressive interventions. She was referred for hospice care and died shortly after.

References

Severe Influenza A(H1N1) Virus Infection Complicated by Myositis, Refractory Rhabdomyolysis, and Compartment Syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374868/

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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