title: Sudden death of an immunocompetent young adult caused by novel (swine origin) influenza A/H1N1-associated myocarditis.
abstract: The main cause of death from novel (swine origin) influenza A/H1N1 infection is acute respiratory distress syndrome. Most fatal cases are immunocompromised patients or patients with a severe underlying disease. Here, we report a fatal case of acute interstitial myocarditis associated with novel influenza A/H1N1 infection in an immunocompetent young woman. A previously healthy 18-year-old woman experienced malaise, diarrhea, and fever for several days prior to a sudden collapse at home. Autopsy revealed a predominantly lymphocytic myocarditis in the absence of a significant respiratory tract infection. Infection with novel (swine origin) influenza A/H1N1 was confirmed by PCR analysis of blood as well as myocardial tissue. Influenza-caused diarrhea with consecutive hypokalemia potentially contributed to the fatal outcome of the myocarditis, characterized by ventricular fibrillation. In conclusion, sudden death by myocarditis may be a rare complication of novel influenza A/H1N1 infection in otherwise healthy individuals, even in the absence of significant respiratory tract infection.
authors.affiliation: Institute of Pathology, University Hospital, Im Neuenheimer Feld 220/221, 69120, Heidelberg, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Gdynia
authors.forename: Paul
authors.initials: P
authors.lastname: Schnitzler
authors.forename: Eva
authors.initials: E
authors.lastname: Brunner
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kandolf
authors.forename: Hendrik
authors.initials: H
authors.lastname: Bläker
authors.forename: Edith
authors.initials: E
authors.lastname: Daum
authors.forename: Philipp
authors.initials: P
authors.lastname: Schnabel
authors.forename: Peter
authors.initials: P
authors.lastname: Schirmacher
authors.forename: Wilfried
authors.initials: W
authors.lastname: Roth
mesh_terms: D000293:Adolescent; D004279:DNA, Viral / Q000032:analysis; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007121:Immunocompetence; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics / Q000302:isolation & purification*; D007251:Influenza, Human / Q000473:pathology / Q000821:virology*; D009205:Myocarditis / Q000473:pathology* / Q000821:virology; D016133:Polymerase Chain Reaction
chemical_list: D004279:DNA, Viral