A Case of Influenza Associated Fulminant Myocarditis Successfully Treated with Intravenous Peramivir
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We report the case of a patient with fulminant myocarditis caused by influenza A virus, who presented with acute-onset heart failure and cardiogenic shock and was treated successfully with single dose of intravenous peramivir and with pharmacologic hemodynamic support. A 45-year-old Korean woman presented to our emergency department (ED) with shortness of breath and an episode of seizure that developed abruptly 5 hours before she arrived in the ED. She had a history of recurrent epileptic seizure 25 years ago, but denied other specific medical illnesses. In the ED, she was hypoxemic (arterial partial pressure of oxygen, 59.8 mmHg on room air) and chest radiography revealed bilateral alveolar infiltrates. A rapid antigen test for influenza A virus was positive, and she was administered a single dose of peramivir (300 mg) intravenously. Five hours later, the patient’s dyspnea had worsened and she was hypotensive (blood pressure, 86/53 mmHg), requiring norepinephrine infusion. Further evaluation disclosed an increased cardiac troponin I level of 1.36 ng/mL and a depressed left ventricular ejection fraction of 30%. Under the diagnosis of influenza A-associated myocarditis and cardiogenic shock, she was managed with continuous critical care in the intensive care unit. On day 3, the patient’s dyspnea began to resolve and her ventricular function returned to normal. Real-time polymerase chain reaction assays for influenza viruses in serial nasopharyngeal aspirates were positive for influenza A (hH3N2) with a threshold cycle value of 27.39 on day 2, but these became negative by day 4. The patient recovered and was discharged on day 9 after admission. In conclusion, this case indicates that intravenous peramivir might be an effective antiviral agent for the treatment of severe influenza A virus infection.
Abstract
We report the case of a patient with fulminant myocarditis caused by influenza A virus, who presented with acute-onset heart failure and cardiogenic shock and was treated successfully with single dose of intravenous peramivir and with pharmacologic hemodynamic support. A 45-year-old Korean woman presented to our emergency department (ED) with shortness of breath and an episode of seizure that developed abruptly 5 hours before she arrived in the ED. She had a history of recurrent epileptic seizure 25 years ago, but denied other specific medical illnesses. In the ED, she was hypoxemic (arterial partial pressure of oxygen, 59.8 mmHg on room air) and chest radiography revealed bilateral alveolar infiltrates. A rapid antigen test for influenza A virus was positive, and she was administered a single dose of peramivir (300 mg) intravenously. Five hours later, the patient’s dyspnea had worsened and she was hypotensive (blood pressure, 86/53 mmHg), requiring norepinephrine infusion. Further evaluation disclosed an increased cardiac troponin I level of 1.36 ng/mL and a depressed left ventricular ejection fraction of 30%. Under the diagnosis of influenza A-associated myocarditis and cardiogenic shock, she was managed with continuous critical care in the intensive care unit. On day 3, the patient’s dyspnea began to resolve and her ventricular function returned to normal. Real-time polymerase chain reaction assays for influenza viruses in serial nasopharyngeal aspirates were positive for influenza A (hH3N2) with a threshold cycle value of 27.39 on day 2, but these became negative by day 4. The patient recovered and was discharged on day 9 after admission. In conclusion, this case indicates that intravenous peramivir might be an effective antiviral agent for the treatment of severe influenza A virus infection.
참고문헌 (15)
- World Health Organization, "Vaccines against influenza WHO position paper - November 2012", Wkly Epidemiol Rec, 87, pp.461~476 (2012)
- Kuiken T, "Pathology of human influenza revisited", Vaccine, 26(Suppl 4), pp.D59~D66 (2008)
- Estabragh ZR, "The cardiovascular manifestations of influenza: a systematic review", Int J Cardiol, 167, pp.2397~2403 (2013)
- Birnkrant D, "The emergency use authorization of peramivir for treatment of 2009 H1N1 influenza", N Engl J Med, 361, pp.2204~2207 (2009)
- Moore DL, "Surveillance for influenza admissions among children hospitalized in Canadian immunization monitoring program active centers, 2003-2004", Pediatrics, 118, pp.e610~e619 (2006)
- Gupta S, "Fulminant myocarditis", Nat Clin Pract Cardiovasc Med, 5, pp.693~706 (2008)
- Ukimura A, "Myocarditis associated with influenza A H1N1pdm2009", Influenza Res Treat, 2012, pp.351979~ (2012)
- Yoshimizu N, "Repetitive fulminant influenza myocarditis requiring the use of circulatory assist devices", Intern Med, 53, pp.109~114 (2014)
- Rogers VL, "Presentation of seasonal influenza A in pregnancy: 2003-2004 influenza season", Obstet Gynecol, 115, pp.924~929 (2010)
- Ando M, "Virus associated hemophagocytic syndrome accompanied by acute respiratory failure caused by influenza A (H3N2)", Intern Med, 45, pp.1183~1186 (2006)
- Nolte KB, "Influenza A virus infection complicated by fatal myocarditis", Am J Forensic Med Pathol, 21, pp.375~379 (2000)
- Ison MG, "Intravenous peramivir for treatment of influenza in hospitalized patients", Antivir Ther, 19, pp.349~361 (2014)
- Hernandez JE, "Clinical experience in adults and children treated with intravenous peramivir for 2009 influenza A (H1N1) under an Emergency IND program in the United States", Clin Infect Dis, 52, pp.695~706 (2011)
- Cobas M, "Successful management of fulminant influenza A subtype H1N1 myocarditis", BMJ Case Rep, 2010, pp.bcr0220102~ (2010)
- "Rapivab (peramivir injection)package insert" (2014)[URL]