case_images: PMC5296325_01
case_images: Complications of seasonal influenza A may include (A) secondary bacterial pneumonia as demonstrated by the left mid-lung homogenous opacity on chest X-radiography, (B) myopericarditis as shown classically by electrocardiogram with diffuse ST elevations and PR depressions, and (C) diffuse cerebral edema not excluding viral encephalitis as revealed by computed tomography of the brain.
case_images: fpubh-05-00001-g001.jpg
case_images: PMC5296325_01_fpubh-05-00001-g001.jpg
case_images: F1
case_images: Chest radiography revealed a homogenous left mid-lung infiltrate with possible cavitation (Figure 1A). Inability to wean vasopressors prompted investigation of cardiac function which unveiled myopericarditis: ECG with diffuse ST elevations and PR depressions most significantly in the late precordial leads to reciprocal changes in aVR (Figure 1B) and peak troponin T of 4.07 ng/ml, and transthoracic echocardiogram (TTE) disclosed severe global left ventricular hypokinesis with an ejection fraction of 25% and right ventricular dysfunction. Despite discontinuation of sedation, her neurologic examination remained poor and CT brain obtained on hospital day 5 disclosed generalized cerebral edema with decreased differentiation of the gray-white matter junction (Figure 1C).