A Case of Influenza Subtype A Virus-Induced Fulminant Myocarditis: An Experience of Percutaneous Cardio-Pulmonary Support (PCPS) Treatment and Immunohistochemical Analysis.

Abstract

A 64-year-old man was admitted to the emergency center of Furukawa City Hospital because of common cold-like symptoms and hypotension. He was diagnosed as fulminant myocarditis with cardiogenic shock and arrhythmia elicited by influenza virus subtype A. Cardiac angiography, echocardiography and biopsy also showed myocarditis, and serum antibody titer to influenza virus subtype A was increased to 4-fold in paired serums. Treatments of both percutaneous cardio-pulmonary support (PCPS) and intra-aortic balloon pumping (IABP) were carried out to sustain the general circulation. PCPS treatment was discontinued on the 25th day of the admission, but IABP was continued. Finally, he died of multiple organ failure. The autopsy revealed myocardial necrosis with a slight fibrosis and a small amount of lymphocytic infiltration into the ventricular wall, which were compatible with restrictive myocarditis. Moreover, immunohistochemical analysis also showed the presence of viral antigens in cardiac myocytes. This case clearly showed that PCPS and IABP can be beneficial to sustain the general circulation in fulminant myocarditis, but cardiac pumping function failed completely to recover from myocardial damage.

Fulminant myocarditis demonstrating uncommon morphology?a report of two autopsy cases

“…Koga et al [14] reported two child cases in which herpes simplex virus-1-or Epstein-Barr virus-positive signals were observed in the nuclei of myocardiac fibers. In addition, Miura et al [18] observed the presence of influenza A in cardiac myocytes using an immunohistochemical analysis with patient's immunoglobulins.…”

Fatal influenza A infection with Staphylococcus aureus superinfection in a 49-year-old woman presenting as sudden death

“…Fatal influenza infection can be caused by influenza pneumonia alone, by respiratory complications caused by bacterial superinfection or by extrapulmonary influenzaassociated manifestations such as myocarditis or encephalopathy [6,8,9]. In the present case, extrapulmonary infectious alterations were ruled out histologically.…”

“…Influenza virus is a globally important respiratory pathogen with a high degree of morbidity and mortality, particularly in risk groups such as elderly persons. Only a few case reports of fatal influenza infections in young patients, most often complicated by influenza-associated myocarditis, have been published during the last decade [6,7,8,9]. A potential differential diagnosis, in both the clinical as well as autopsy setting, is hemorrhagic necrotizing pneumonia caused by Panton-Valentine leukocidin-producing Staphylococcus aureus strains.…”

The Single-Step Multiplex Reverse Transcription- Polymerase Chain Reaction Assay for Detecting H5 and H7 Avian Influenza A Viruses

“…Among 16 HA subtypes, only H5 and H7 are virulent in poultry. In contrast, only three HA subtypes (H1, H2 and H3) and two NA subtypes (N1 and N2) have commonly been found in humans (Ohrui et al 2000;Miura et al 2001). However, over the past few years, several subtypes of AI virus including H5N1, H7N7, H7N3 and H9N2 have directly crossed the species barrier to infect humans (Rezza 2004).…”