Severe Pneumonia and Convulsion Caused by Influenza H1N1 Virus in an Asthma Patient: Case Report
Oner Ozdemir, Emine Kurt
2017
Istanbul Medical Journal
Pandemic influenza A (H1N1) virus, unlike seasonal influenza, has a high attack rate and contagiousness (1). While the pandemic influenza virus shows symptoms like many seasonal influenza viruses in many people, unlike seasonal influenza, it may cause severe infections in healthy and young adults. These clinical differences between seasonal and pandemic influenza are shown in Table 1 . It can cause more serious infections and deaths in those with underlying chronic illnesses, such as asthma, in
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... infants, children aged under 5 years, and the elderly (1, 2). In this case report, we present a 12-year-old patient who had asthma as an underlying chronic disease, who applied to our clinic with the complaint of attacks and had bacterial pneumonia and convulsions secondary to pandemic influenza. Case Report A 12-year-old girl who complained of a 1-month-long cough and newly started shortness of breath was hospitalized with the diagnosis of asthma by the polyclinic that followed up the patient. The weight of the patient was 30 kg, height was 157 cm, fever at the time of admission was 36.5°C, respiratory rate was 42/min, arterial tension was 105/54 mmHg, pulse was 154/min, and saturation was 96%. While the patient was receiving asthma attack treatment and recovering in the clinic, she began to develop fever, malaise, loss of appetite, and widespread muscle pain on the third day of hospitalization. On the following day, diarrhea and vomiting occurred two to three times. Then, leukopenia, anemia, and thrombocytopenia developed. In the laboratory examination of the patient at this time, leukocyte was 3,470/mm 3 , hemoglobin was 10.7 g/dL, platelet was 137,000/mm 3 , C-reactive protein (CRP) was 81mg/ L (normal: <5), sedimentation was 89/h, aspartate aminotransferase (AST) was 430 U/L, alanine transaminase (ALT) was 320 U/L, and lactate dehydrogenase (LDH) was 1524 U/L. Posterioanterior (PA) chest X-ray showed consolidation (pneumonic infiltration) in the bilateral basal segments (Figure 1 ). Meropenem treatment was initiated in the patient. The patient did not have any previous history of convulsion and experienced a tonic-clon-Severe Pneumonia and Convulsion Caused by Influenza H1N1 Virus in an Asthma Patient: Case Report Pandemic influenza virus (H1N1) has a higher attack rate than seasonal influenza virus and is more contagious than seasonal influenza infection. H1N1 infection might cause more severe disease leading to death, if patients have a debilitating chronic disease such as asthma or are pregnant, elderly, and younger than 5 years. The case of a 12-year-old asthmatic patient with pneumonia and convulsion secondary to H1N1 infection during her asthma attack is presented. The 12-year-old asthmatic patient presented with one-month history of coughing and dyspnea. When she was admitted, her fever was 36.5°C, respiratory rate was 42/minute, blood pressure was 105/54 mmHg, pulse was 154/minute, and oxygen saturation was 96%. Her physical examination revealed rhonchi and crackles on her lung. When her asthma attack improved at the day 3 after admission, she began to experience fever, fatigue, anorexia, and myalgia. She then had diarrhea and vomiting. Laboratory test results revealed anemia (Hemoglobin: 10.7g/dL), leucopenia (3.470) and thrombocytopenia (137,000). She had a C reaktif protein (CRP) level of 81, Sedimentasyon (ESR) of 89 mm, Aspartat aminotransferaz (AST) level of 430 U and Alanin transaminaz (ALT) level of 320 U. Her chest X-ray demonstrated bilateral consolidations at the lung bases. Cefuroxime was replaced with meropenem, azithromycin, and vancomycin when her fever did not resolve. During this febrile episode, she had an afebrile tonic-clonic convulsion. Lumbar puncture and magnetic resonance imaging (MRI) revealed normal findings. Her fever and symptoms were thought to be due to H1N1 infection, and oseltamivir was started; her fever resolved next day. On the 10th day after her admission, H1N1 was detected in her nasopharyngeal swab. When an asthmatic patient has an unknown origin of fever that leads to pneumonia and convulsion, pandemic influenza infection should be kept in mind. Abstract 1
doi:10.5152/imj.2017.66487
fatcat:jjol3zmrobhalf7v2awuu4v6ae