SESSION TITLE: Critical Care 4 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: H1N1 Subtype Influenza Type A, strain responsible for the 2009 pandemic, is primary regarded as a disease affecting lung parenchyma, yet it is its ability to infiltrate and cause system wide complications which has made it such a deadly virus. It is hypothesized the disease process may cause a propensity for thromboembolic events through activation of platelets, alterations of coagulation factors, or endothelial dysfunction. There have been multiple documented cases of pulmonary embolism and myocardial infarctions in prior reports in H1N1 infected individuals, but few of cerebral events. We present a unique case of a previously healthy 47 year old male with severe H1N1-influenza whose hospital course was complicated by multiple cerebral infarcts and R-femoral DVT. CASE PRESENTATION: 47 year old caucasian male without a significant PMHx presented initially for fevers, myalgias, and respiratory distress requiring intubation at an outside facility. The patient’s condition worsened and was transferred to our facility for higher level of care. He was initially found to to have septic shock and started on empiric antibiotics. PCR was positive for H1N1 flu, oseltamivir was initiated. The pt underwent a bronchoscopy with washings. He continue to have fevers although multiple cultures of blood, bronchial washings, sputum were negative for any growth bacterial or fungal growth. On day 4, the patient was found to have a DVT of R-femoral vein and started on a heparin drip; of note, chemical DVT prophylaxis was initiated at time of admission. The pt had difficulty with arousability off sedation and underwent extensive neurological workup including CSF studies which were negative. MRI was significant for multiple small bilateral cerebral infarcts. Repeat echos were negative for signs of endocarditis or PFO on bubble study. Pt improved following tracheostomy placement and was discharged to LTAC on day 17th of hospitalization. DISCUSSION: The clinical course of this case was particularly challenging due to the severity of illness and continual negative initial workup of the pt. The pt continued to have poor neurological improvement. Although multiple strokes were seen on head MRI, the territories were small and unlikely to have accounted for the pt’s decreased arousability. One possibility could have been influenza-associated encephalitis which is a rare complication and likely under-diagnosed given lack of distinctive clinical symptoms and diagnostic criteria. CSF studies were unremarkable but difficulty in obtaining influenza PCR on CSF limited our results. CONCLUSIONS: This case serves to illustrate the widespread effects of Influenza Type A H1N1, even in healthy individuals. In this particular case, the pt had both venous and arterial thromboembolic events which is unique. It is important to keep in mind the extent of the disease process in this disease, especially in critically-ill patients. Reference #1: Dimitroulis, I. A., Katsaras, M., & Toumbis, M. (2016). H1N1 infection and embolic events: A multifaceted disease. Pneumon, 29(3), 230-235. Reference #2: Coorevits, L., Demuynck, H., Boone, E., Roelens, J., & Surmont, I. (2011). Trombo-embolic complications in influenza A(H1N1)2009: A forgotten and fatal danger, also in so-called "mild” flu? [Trombo-embolische Reference #3: Meijer, W. J., Linn, F. H. H., Wensing, A. M. J., Leavis, H. L., van Riel, D., GeurtsvanKessel, C. H., … Murk, J.-L. (2016). Acute influenza virus-associated encephalitis and encephalopathy in adults: a challenging diagnosis. JMM Case Reports, 3(6), e005076. http://doi.org/10.1099/jmmcr.0.005076 DISCLOSURES: No relevant relationships by Donna Cota, source=Web Response No relevant relationships by Luna Liu, source=Web Response No relevant relationships by Robyn Moran, source=Web Response