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Abstract

Introduction: The FDA cautions clinicians that the sensitivity (95% CI: 24-91%) and specificity (95% CI: 69-94%) of Rapid Flu A tests in adults are notoriously poor (FDA, 2013). This is the case of an 18-year-old male admitted from the Emergency Department with a negative Rapid Flu test for ARDS suspected as an inhalation injury (bleach inhalation versus illicit inhalant use). Patient presented with fever, cough, vomiting, diarrhea, headaches and tachypnea and was admitted to an intermediate critical care unit with subsequent ICU transfer for respiratory failure and intubation with a PF ratio of 54 and oxygenation index of 46 with groundglass opacities noted on CT. Extubated after a 16-day course of MV requiring heavy sedation for ventilator synchrony, including high-dose paralytic infusions required to achieve a train of four of 3/4. Large pneumomediastinum and pneumoperitoneum on HD 7 with extensive subcutaneous emphysema resolved without intervention on HD19. Flu A viral cultures from a miniBAL on HD 2 were resulted on HD 11 (variant subtyping not available) and treatment with oseltamivir was initiated. Encephalopathic process identified 2 days after extubation with tonic-clonic seizures with deterioration on HD 26 requiring reintubation for airway protection (2 days). MRI suspicious for acute demyelinating encephalomyelitis treated with IVIG. Patient complained of severe headaches on HD 31 with subsequent progressive left-sided weakness, pronator drift, dysmetria, nystagmus and partial visual field loss noted on HD 33 with a CT revealing 7mm right-to-left midline shift and intraparenchymal hemorrhage and edema. Patient is discharged from the hospital with mild cognitive impairment and left-sided neglect with rehabilitation treatment in progress. The clinical consequences of severe influenza-related infection, in this case an off-season case of untyped flu A, can be broad. In addition to severe respiratory compromise, severe CNS complications and sequelae are noted which are not widely reported in the medical literature. Reference: FDA. (2013). Cautions in using rapid tests for detecting Influenza A viruses. Retrieved August 1, 2013, from http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/TipsandArticlesonDeviceSafety/ucm109385.htm