Methylprednisolone infusion for life-threatening H1N1-virus infection.
BACKGROUND
During winter 2009 we treated with prolonged corticosteroid infusion eight consecutive patients affected by H1N1-virus infection and severe pneumonia. The most severe patient was a previously healthy 30-year-old man admitted to hospital because of bilateral pneumonia and severe acute respiratory failure.


METHODS
H1N1-virus infection was detected by broncho-alveolar lavage performed on day 1. After some days following admission the patient was still in a life-threatening state, not responding to oseltamivir, protective mechanical ventilation and veno-arterial extracorporeal membrane oxygenation (ECMO).


RESULTS
The addition of methylprednisolone infusion at a stress dose (1 mg/kg/24 h) as rescue therapy significantly and rapidly improved the clinical condition. Weaning from ECMO and invasive mechanical ventilation was possible within a relatively few days.


CONCLUSIONS
According to the literature reports more than 34% of H1N1-virus severe infections were treated with corticosteroids. This report and our experience may suggest a possible life-saving use of corticosteroids at a stress dose in severely ill patients with an H1N1-virus infection that is not responding to the most advanced treatments.
Confalonieri
Marco
M
Pneumology Department, University Hospital of Cattinara, Str. Di Fiume 447, 34149 Trieste, Italy. marco.confalonieri@aots.sanita.fvg.it
Cifaldi
Rossella
R
Dreas
Lorella
L
Viviani
Marino
M
Biolo
Marco
M
Gabrielli
Marco
M
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D018893:Bronchoalveolar Lavage / Q000379:methods; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000175:diagnosis / Q000628:therapy* / Q000821:virology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D053139:Oseltamivir / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D000998:Antiviral Agents; D005938:Glucocorticoids; D053139:Oseltamivir; D008775:Methylprednisolone