A 1-year-old 8-month-old boy with Down syndrome, without heart disease or other chronic treatment, was admitted for mild respiratory distress.
Chest X-ray showed bilateral diffuse parahilar infiltrate.
Symptomatic treatment with aerosols (albutamol, 2 every 4 h; budesonide puff pulse, ipratropium pulse) and antibiotics (clarified oxygen ceftriaxone) were indicated.
It presents virological decrements of nasopharyngeal secretions for non-respiratory dengue virus and its subtypes, influenza and subtypes, adenovirus negative (indirect immunofluorescence method [IFI]).
A week after admission, and after worsening of the clinical picture, PCR of total pharyngeal secretions for influenza A H1N1 was requested and oseltamivir 30 mg/kg oral treatment was added according to the recommendations of the Ministry of Health.
The positive result for influenza A H1N1 confirms the diagnosis.
After four days of MRA, the patient was discharged with clear clinical improvement.
Twelve days after starting treatment with oseltamivir, the patient begins with erythematous purpuric lesions, initially in pressure zones, which extend in the napa and compromise the entire tegument.
Skin detachment with formation of isolated blisters, with cheilitis and mild conjunctival secretion was observed.
There is evidence of increased transaminase and erythrosedimentation.
The serology for Mycoplasma, Epstein-acquired cytomegalovirus and parvovirus was negative.
Intravenous gammaglobulin 1 g/kg/day was started for three days, after the first infusion the appearance of new lesions ceased and, after the third dose, the clinical picture completely reverted leaving only residual hyperpigmentation.
There were no further relapses or mucosal sequelae.
Skin biopsy reports epidermal necrolysis.
