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/
