Abstract
A 63-year-old man visited a local clinic because of fever. He tested positive for influenza virus A H1N1 antigen, and was administered oseltamivir. On the fifth day of illness, he showed severe respiratory failure. Therefore, he was transported to our hospital, placed on noninvasive positive airway pressure ventilation, and started on peramivir, short-term high-dose steroid therapy. On the sixth day of illness, he developed disseminated intravascular coagulation (DIC), which was treated with anticoagulation therapy. Because the dyspnea worsened, he was intubated on the 13th day of illness, and placed on extracorporeal membrane oxygenation (ECMO) on the next day. However, because his condition did not improve, he had to be placed on ECMO for a long period of time. The patient's condition was complicated by upper gastrointestinal bleeding on the 34th day, and he died of multiple organ dysfunction on the 52nd day. This case suggests that such patients should be carefully managed with bleeding complications in mind, because treatment with ECMO is associated with the development of DIC-like conditions.
