Severe Pneumonia and Convulsion Caused by Influenza H1N1 Virus in an Asthma Patient: Case Report

Abstract

Pandemic influenza virus (H1N1) has a higher attack rate than seasonal influenza virus and is more contagious than seasonal influenza infection. H1N1 infection might cause more severe disease leading to death, if patients have a debilitating chronic disease such as asthma or are pregnant, elderly, and younger than 5 years. The case of a 12-year-old asthmatic patient with pneumonia and convulsion secondary to H1N1 infection during her asthma attack is presented. The 12-year-old asthmatic patient presented with one-month history of coughing and dyspnea. When she was admitted, her fever was 36.5 degrees C, respiratory rate was 42/minute, blood pressure was 105/54 mmHg, pulse was 154/minute, and oxygen saturation was 96%. Her physical examination revealed rhonchi and crackles on her lung. When her asthma attack improved at the day 3 after admission, she began to experience fever, fatigue, anorexia, and myalgia. She then had diarrhea and vomiting. Laboratory test results revealed anemia (Hemoglobin: 10.7g/dL), leucopenia (3.470) and thrombocytopenia (137,000). She had a C reaktif protein (CRP) level of 81, Sedimentasyon (ESR) of 89 mm, Aspartat aminotransferaz (AST) level of 430 U and Alanin transaminaz (ALT) level of 320 U. Her chest X-ray demonstrated bilateral consolidations at the lung bases. Cefuroxime was replaced with meropenem, azithromycin, and vancomycin when her fever did not resolve. During this febrile episode, she had an afebrile tonic-clonic convulsion. Lumbar puncture and magnetic resonance imaging (MRI) revealed normal findings. Her fever and symptoms were thought to be due to H1N1 infection, and oseltamivir was started; her fever resolved next day. On the 10th day after her admission, H1N1 was detected in her nasopharyngeal swab. When an asthmatic patient has an unknown origin of fever that leads to pneumonia and convulsion, pandemic influenza infection should be kept in mind.