Abstract
BackgroundImmunocompromised patients, particularly after lung transplantation, are at high risk to develop atypical forms of pulmonary infections including influenza A/H1N1. Acute Fibrinous and Organizing Pneumonia (AFOP) is a special histological pattern in acute respiratory failure with high mortality.Case presentationWe describe a 66-year-old woman with double lung transplantation in August 2009 due to end stage pulmonary fibrosis. After prolonged weaning and subsequent promising course, she developed atypical pneumonia with diffuse pulmonary infiltrates in both lungs in January 2010. Infection with influenza A/H1N1 virus was verified. The patient rapidly suffered from respiratory insufficiency and died eight days after this diagnosis. The post-mortem revealed especially in the lower parts of the lungs the classical histological pattern of pure AFOP. Molecular analyses of lung tissue were positive for influenza A/H1N1.ConclusionTo our knowledge we present the first case of AFOP triggered by viral infection, here proven to be influenza virus A/H1N1. Thus, also in the setting of viral infection the highly deadly differential diagnosis of AFOP must be considered.
Highlights
Immunocompromised patients, after lung transplantation, are at high risk to develop atypical forms of pulmonary infections including influenza A/H1N1
To our knowledge we present the first case of AFOP triggered by viral infection, here proven to be influenza virus A/H1N1
Influenza A/H1N1 pneumonia can lead to severe respiratory conditions in this patient group often resulting in deadly respiratory insufficiency
Summary
Concluding, for the first time proof is given that viral agents at least of the myxovirus family - here influenza A/H1N1 - can induce pure often fatal AFOP. AFOP in the setting of viral pneumonia must be taken into account especially in immunocompromised patients as successful treatment with a combination of corticosteroids and mycophenolate-mofetil has recently been reported [14]. Consent Informed and written consent for post-mortem investigation, scientific research and following publication as clinical image was given by the patient prior to death. Authors’ contributions CO, GK: autopsy workup, preparation of the manuscript. DH: virological investigations, preparation of the manuscript. LK: radiological evaluation, preparation of the manuscript. CB, AH, SR, TP: clinical care, provision of clinical data, proof reading. MW: Histological evaluation, methodological support, proof reading. All authors read and approved the final manuscript
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