Influenza A/H1N1 septic shock in a patient with systemic lupus erythematosus. A case report

Abstract

BackgroundImmunocompromised patients, such as systemic lupus erythematosus (SLE) sufferers have an increased risk of mortality, following influenza infection. In the recent pandemic, influenza A H1NI virus caused 18449 deaths, mainly because of adult respiratory distress syndrome or bacterial co-infections.Case PresentationIn this case report, an SLE patient with viral-induced septic shock, without overt pulmonary involvement, is discussed. The patient was administered oseltamivir and supportive treatment, including wide-spectrum antibiotics, vasopressors and steroids, according to the guidelines proposed for bacterial sepsis and septic shock. She finally survived and experienced a lupus flare soon after intensive care unit (ICU) discharge.ConclusionsTo our knowledge, this is the first case to report severe septic shock from influenza A/H1N1 virus, without overt pulmonary involvement.

Severe Sepsis and Septic Shock Associated with Chikungunya Virus Infection, Guadeloupe, 2014

“…By contrast, cases of virus-triggered septic shock have been reported only rarely ( 13 ), although a recent cross-sectional study of septic shock syndromes in a pediatric population suggested that viruses might be the only etiology in up to 10% of cases ( 14 ). On the other hand, genuine acute severe viral infections might be complicated with a bacterial septic shock, which is well known to occur in cases of influenza but has also been reported in cases of arboviral diseases, such as dengue fever ( 15 ).…”

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

“…37 Influenza pneumonia often precedes bacterial infections, which may lead to prolonged hospitalizations and overall worse outcomes. 38,39 In patients with SLE, viral infections can also trigger SLE flares after the virus is cleared. 39,40 In comparison, Influenza A infection in lupus-prone Fas lpr mice is cleared effectively and is not associated with worsening autoimmune features in the acute setting, although these mice can subsequently develop severe pulmonary inflammation weeks after viral clearance.…”

“…38,39 In patients with SLE, viral infections can also trigger SLE flares after the virus is cleared. 39,40 In comparison, Influenza A infection in lupus-prone Fas lpr mice is cleared effectively and is not associated with worsening autoimmune features in the acute setting, although these mice can subsequently develop severe pulmonary inflammation weeks after viral clearance. 41 Notably, annual vaccination against influenza is associated with decreased hospitalization and ICU admissions in patients with SLE; hence this practice is highly encouraged.…”

Influenza SIRS with Minimal Pneumonitis

“…While cases of primary influenza SIRS without pneumonia may be embedded in case series (4–6), we could find only two cases of influenza SIRS, explicitly described to have no pneumonia (7, 8). …”

“…Although there are many reports of SIRS associated with influenza, few if any cases have been described without primary lung involvement, i.e., influenza pneumonia/ARDS. While cases of primary influenza SIRS without pneumonia may be embedded in case series ( 4 – 6 ), we could find only two cases of influenza SIRS, explicitly described to have no pneumonia ( 7 , 8 ).…”