A simple case of ‘flu’ can turn out to be a serious affair. We present a case of H1N1 virus infection deteriorating into acute respiratory distress syndrome (ARDS).
A 20 years old lady, gravida 3 para 1+1 at 37 weeks was admitted for delivery. On the day of admission, she had cough and runny nose and treated as maternal upper respiratory tract infection. She successfully underwent emergency caesarean due to fetal distress. On day 4 post-operatively, her oxygen saturation dropped to 78%.She developed a self-aborted seizure and intubated subsequently.There were lung crepitations up to midzone on the right and at the lower zone on the left. The CXR showed generalized haziness. The blood gas showed type 2 respiratory failure. She was treated as community-acquired pneumonia and CT pulmonary angiogram done subsequently ruled out pulmonary embolism. She was started with augmentin and azithromycin. Patient was transferred to the ICU and treated as CAP with acute respiratory distress syndrome (ARDS) with PaO2/FiO2 ratio less than 150. Her antibiotic was escalated to Tazocin and Tamiflu was added to cover for viral infection. Bronchoscope was done and the culture grew H1N1 virus. Patient had to be ventilated in prone position for 16 hours in view of persistent hypoxia (<88%). The lung ultrasound showed hepatization pattern with air bronchogram, multiple B-lines and pleural effusion bilaterally. Subsequently, patient improved and could be extubated. She recovered well and was able to be discharged after 2 weeks in the hospital.
Discussion & Conclusion
A simple ‘flu-like’ illness can turn out to be a severe case of influenza with ARDS complication. The H1N1 can progress with very severe symptoms.Antiviral treatment must be covered concomitantly while awaiting culture results. Early intervention may mitigate disease progression. The ‘prone’ position was effective in improving patient’s respiration and recovery.
pregnancy, Influenza A H1N1, ARDS