Sudden death of a patient with pandemic influenza (A/H1N1pdm) virus infection by acute respiratory distress syndrome.
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.
Takiyama
Akihiro
A
Laboratory of Cancer Research, Department of Pathology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
Wang
Lei
L
Tanino
Mishie
M
Kimura
Taichi
T
Kawagishi
Naoki
N
Kunieda
Yasuyuki
Y
Katano
Harutaka
H
Nakajima
Noriko
N
Hasegawa
Hideki
H
Takagi
Tomoyuki
T
Nishihara
Hiroshi
H
Sata
Tetsutaro
T
Tanaka
Shinya
S
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
D000956:Antigens, Viral; D000998:Antiviral Agents; D012367:RNA, Viral; D053139:Oseltamivir