Abstract
We described a case of persistent influenza AH1N1 and cytomegalovirus respiratory infection in a patient with chronic interstitial lung disease and multiple bilateral pulmonary opacities. An open lung biopsy revealed diffuse organizing alveolar damage, necrotizing bronchiolitis, necrotizing pneumonia and alveolar hemorrhage, compatible with H1N1 infection as well as usual interstitial pneumonia. Diagnoses of an idiopathic CD4+ T cell lymphocytopenia and immunoglobulin G deficiency were made as an unexpected co-denominator of H1N1 and CMV persistent infection changing our treatment approach.
Highlights
We described a case of persistent influenza AH1N1 and cytomegalovirus respiratory infection in a patient with chronic interstitial lung disease and multiple bilateral pulmonary opacities
After the surgical procedure she evolved with progressive worsening of dyspnea when a diagnosis of respiratory infection due to Influenza AH1N1 virus was made
The H1N1 infection had been treated previously with oseltamivir, and its de novo identification was interpreted as persistence of H1N1, especially in the setting of an idiopathic CD4+ T cell lymphocytopenia (ICL) [4,5]
Summary
We described a case of persistent influenza AH1N1 and cytomegalovirus respiratory infection in a patient with chronic interstitial lung disease and multiple bilateral pulmonary opacities. Olsetamivir, intravenous methylprednisolone (40 mg/day) and respiratory support (Venturi mask with 50% FiO2) were used for five days and the patient showed improvement that lasted for two days. A chest computed tomography (CT) scans revealed diffuse ground glass pattern, multiple nodular opacities, peripheral lung cysts and bronchiolectasis (Figure 3).
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