title: Sudden death of a patient with pandemic influenza (A/H1N1pdm) virus infection by acute respiratory distress syndrome.
abstract: We describe an autopsy case of a patient with pandemic influenza (A/H1N1pdm) virus infection in Japan, who developed rapidly progressive viral pneumonia exhibiting diffuse alveolar damage. A 41-year-old female visited our hospital with a fever of 38.7C. She was a public health nurse with no underlying disease and had had contact with a group of elementary school students who had been infected with the influenza (A/H1N1pdm) virus 1 week earlier. She was prescribed oseltamivir and returned to the hotel where she was staying alone. The next day, she was found dead in her hotel room. At autopsy, both lungs were voluminous and microscopic examination revealed acute-stage, severe diffuse alveolar damage with remarkable mononuclear cell infiltration and hyaline membrane formation in the lungs. CD8-positive T lymphocytes were dominantly observed. Immunohistochemically, influenza A viral protein was confirmed in the damaged type II pneumocytes and also in the infiltrated macrophages. Real-time RT-PCR analysis of both pre- and post-mortem pharyngeal swabs confirmed a novel influenza (A/H1N1pdm) virus infection. This is the second autopsy case of influenza (A/H1N1pdm) virus infection in Japan, and the findings indicated that the patient died due to an exceptionally rapid progression of viral pneumonia. This case indicates that patients with influenza (A/H1N1pdm) virus infection should be carefully monitor for acute respiratory distress syndrome.
authors.affiliation: Laboratory of Cancer Research, Department of Pathology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Takiyama
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Mishie
authors.initials: M
authors.lastname: Tanino
authors.forename: Taichi
authors.initials: T
authors.lastname: Kimura
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawagishi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kunieda
authors.forename: Harutaka
authors.initials: H
authors.lastname: Katano
authors.forename: Noriko
authors.initials: N
authors.lastname: Nakajima
authors.forename: Hideki
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Takagi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishihara
authors.forename: Tetsutaro
authors.initials: T
authors.lastname: Sata
authors.forename: Shinya
authors.initials: S
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000956:Antigens, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000627:therapeutic use; D003645:Death, Sudden; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D007564:Japan; D008168:Lung / Q000473:pathology; D009305:Nasopharynx / Q000821:virology; D053139:Oseltamivir / Q000627:therapeutic use; D012367:RNA, Viral / Q000032:analysis; D012128:Respiratory Distress Syndrome / Q000150:complications*; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D000956:Antigens, Viral; D000998:Antiviral Agents; D012367:RNA, Viral; D053139:Oseltamivir