This is a 66-year-old male with a history of lung cancer (non-small cell carcinoma stage iiiB) treated with chemotherapy and radiotherapy, who is free of disease, with subsequent appearance of a brain metastasis on which holocraneal resection is performed pending.
She came to the emergency department with dyspnea on minimal exertion for 10 days and fever of up to 39°C. She denied cough and expectoration.
There is no relevant epidemiological background.
Antibiotic treatment was started on an outpatient basis without improvement.
Upon arrival, she had severe respiratory failure requiring high FiO2, so she was admitted to the critical care unit of our center.
It presents rapid progression of respiratory failure and requires orotracheal intubation and mechanical ventilation 24h later.
The initial chest X-ray showed an alveolar infiltrate in the left base with bilateral pulmonary infiltrates in subsequent controls.
Catheterization of the pulmonary artery was performed, ruling out heart failure, with pulmonary capillary pressure below 18mmHg, and showing signs of moderate pulmonary hypertension.
Analytically, disseminated intravascular coagulation (D05 and elevated lactate 20,000ng/ml), maximum thrombocytopenia 47,000/l and maximum prothrombin time 2.3mg/dl, acute renal failure stand out.
Antibiotic treatment was initiated empirically with piperacillin-tamethasone and tape, and corticosteroids were added later.
Given the poor evolution, with persistence of severe respiratory failure and worsening of pulmonary infiltrates of unrelated cause, a chest CT is performed showing bilateral parenchymal involvement very extensive in ground-glass or infectious character that indicates diffuse alveolar damage.
Bronchoalveolar lavage was performed with negative bacteriological culture, Ziehl-Nielsen negative and cystis jirovecii negative.
Serology of positive pneumonia was requested to diagnose leptospirosis (Legionella, Chlamydia, etc.) which are negative and, finally, due to the clinical characteristics and probable pandemic situation for influenza A (H1N1) virus is added.
The patient has a good clinical evolution with rapid improvement of the infiltrates, and wean the ventilation without incidents.
The patient was discharged after one month of hospitalization.
1.
Of the health professionals who cared for the patient presented symptoms indicative of influenza in the following days.
