Abstract
We describe a patient who survived 2009 influenza A/H1N1-associated fulminant myocarditis with critical care including percutaneous cardiopulmonary support (PCPS). A 24-year-old female was diagnosed in November 2009 with influenza A and received oseltamivir. Although her fever decreased, she experienced frequent vomiting and diarrhea 5 days after disease onset and was transfered to our hospital the following day. Electrocardiograms showed ST-segment elevation in leads II, III, aVF, and V3-6, with increase in creatine kinase and troponin T levels. Cardiac ultrasonography revealed marked overall reduction of wall motion, establishing a diagnosis of myocarditis. Following ICU admission, general management was provided by intraaortic balloon pumping (IABP) with catecholamines, with continuous homodiafiltration (CHDF) to address acute renal failure. Next morning, cardiopulmonary arrest was happened and PCPS was initiated. Following PCPS circuit replacement on day 4, cardiac function gradually improved till weaning from both PCPS and IABP on day 7 and CHDF on day 8. Prolonged mechanical ventilation due to airway hemorrhage and left pulmonary atelectasis ended with tracheal tube removal on day 15. She was discharged without neurological sequelae on day 33. PCPS, initiated without delay upon in-hospital cardiopulmonary arrest, enabled her survival with standard supportive care alone.
