title: Influenza A/H1N1 (2009) infection as a cause of unexpected out-of-hospital death in the young.
abstract: In March 2009, a new strain of influenza A/H1N1 virus was identified in Mexico, responsible for a pandemic. Worldwide, more than 13,500 patients died, most often from acute respiratory distress syndrome. Because sudden death cases were rare, involving mostly young apparently healthy persons, influenza A/H1N1 (2009)-related deaths may be misdiagnosed, which can raise medico-legal issues.
  
  
  METHODS
  we report on an unexpected out-of-hospital death involving a young male with no past medical history and no vaccination. Fever was his only symptom. Laboratory tests: histology showed patchy necrotic foci with mononuclear inflammation in the lungs. The heart was histologically normal, but virological analyses using molecular biology on frozen myocardial samples showed high virus load. In conclusion, this case report shows that influenza A/H1N1 (2009) virus can be a cause of sudden cardiac death in the young and demonstrates the importance of quantitative virological analyses for the diagnosis of myocarditis.
authors.affiliation: Department of Pathology, Academic Hospital, Reims, France. camille.boulagnon@gmail.com
authors.forename: Camille
authors.initials: C
authors.lastname: Boulagnon
authors.forename: Nicolas
authors.initials: N
authors.lastname: Leveque
authors.forename: Fanny
authors.initials: F
authors.lastname: Renois
authors.forename: Laurent
authors.initials: L
authors.lastname: Andreoletti
authors.forename: Paul
authors.initials: P
authors.lastname: Fornes
mesh_terms: D004279:DNA, Viral / Q000235:genetics; D003645:Death, Sudden / Q000209:etiology*; D006321:Heart / Q000821:virology; D006801:Humans; D007249:Inflammation / Q000473:pathology; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics; D007251:Influenza, Human / Q000175:diagnosis*; D008168:Lung / Q000473:pathology; D008297:Male; D009206:Myocardium / Q000473:pathology; D009336:Necrosis; D009666:Nose / Q000821:virology; D060888:Real-Time Polymerase Chain Reaction; D019562:Viral Load; D055815:Young Adult
chemical_list: D004279:DNA, Viral