A 65-year-old male, resident in the Metropolitan Region of Santiago, obese (BMI 31 kg/m2), with no other morbid history.
She did not receive immunization for influenza in 2013.
The patient consulted for a history of a week of evolution characterized by dyspnea of insidious and progressive onset, unquantified fever sensation, compromise of general status and pain in right hemithorax not specified.
On admission, the following vital signs were observed: blood pressure 145/78 mmHg, heart rate 122 bpm, respiratory rate 28 bpm, saturation 87% at room FiO2, and temperature of 39°C axillary.
On physical examination, the patient was clinically well perfused, with globally decreased pulmonary murmur and bilateral diffuse crypts, with no other significant findings.
Initial laboratory tests are described in Table 1.
Chest X-ray revealed opacity in the lower third of the right lung field and other poorly defined small opacities in the left lung field.
1.
The patient was admitted to the intensive care unit with a diagnosis of septic shock associated with a possible pulmonary focus and multiple organ failure, requiring vasoactive antibiotic therapy with invasive mechanical ventilation.
The initial etiological study highlighted a rapid positive test for the detection of streptococcal beta-blockade group A of nasopharyngeal sample.
Gram stain of the tracheal secretion sample showed chain-positive Gram-positive cocci and direct staining of the tracheal secretion sample bottle (+) showed gram-positive cocci.
Both methods later confirmed the development of S. pyogenes.
Antibiotic therapy was adjusted remaining with a scheme of sodium penicillin and clindamycin, maintaining treatment with oseltamivir.
She was also treated with intravenous immunoglobulin G for 3 days.
The rest of the etiological studies are described in Table 2.
Among these, we requested a polymerase chain reaction test for influenza A and B, which was subsequently positive for influenza A H1N1.
1.
Chest computed tomography showed extensive foci of bilateral condensation, especially in the right lower lobe, presenting a central area suggestive of necrosis.
1.
The patient presented with catastrophic respiratory failure and progressive dysfunction requiring life support with extracorporeal membrane organic lysis.
Finally, the patient presented a severe intracerebral haemorrhagic complication and died the same day.
