peramivir and Myocarditis

A 52-year-old man was admitted to our hospital due to shortness of breath that developed one week after the diagnosis of influenza infection. He had a past history of myocarditis associated with influenza B infection 16 years before the current admission. The patient's left ventricular function showed diffuse hypokinesis with a left ventricular ejection fraction of 28%. Due to the progression of heart failure, the infusion of catecholamines and insertion of an intra-aortic balloon pump were required. The patient was discharged uneventfully on the 23rd hospital day. A significant increase in the serum antibody titer against influenza A virus subtype H3N2 led to a diagnosis of recurrent fulminant influenza myocarditis.

Topics: Acids, Carbocyclic; Adult; Antibodies, Viral; Antiviral Agents; Catecholamines; Cyclopentanes; Dyspnea; Electrocardiography; Guanidines; Heart-Assist Devices; Hemodynamics; Humans; Influenza A Virus, H3N2 Subtype; Influenza B virus; Influenza, Human; Intra-Aortic Balloon Pumping; Magnetic Resonance Imaging; Male; Myocarditis; Pericarditis; Recurrence; Ultrasonography; Ventricular Dysfunction, Left

The outbreak and spread of the new influenza A subtype H1N1 reached pandemic levels during 2009, with greater numbers of cases reported daily and numerous complications described. The present report concerns an atypical manifestation of the disease in a previously healthy middle-aged patient who presented with severe, refractory cardiogenic shock 4 days after being diagnosed as having influenza A. The patient was considered for emergency heart transplant. Successful treatment involved the use of a left ventricular assist device, extracorporeal membrane oxygenation, intravenous immunoglobulin and peramivir as therapeutics and bridging therapies for transplant. This case is a report of H1N1 fulminant myocarditis and illustrates the usefulness of a multidisciplinary approach in the care of these patients.

Topics: Acids, Carbocyclic; Antiviral Agents; Combined Modality Therapy; Cyclopentanes; Extracorporeal Membrane Oxygenation; Female; Guanidines; Humans; Immunoglobulins, Intravenous; Influenza A Virus, H1N1 Subtype; Influenza, Human; Middle Aged; Myocarditis; Shock, Cardiogenic