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Respiratory Failure Caused by 2009 Novel Influenza A/H1N1 in a Hematopoietic Stem-Cell Transplant Recipient: Detection of Extrapulmonary H1N1 RNA and Use of Intravenous Peramivir
1. Angela P. Campbell, MD, MPH;
2. Shevin T. Jacob, MD, MPH;
3. Jane Kuypers, PhD;
4. Anna Wald, MD, MPH;
5. Janet A. Englund, MD;
6. Lawrence Corey, MD; and
7. Michael Boeckh, MD
1.
From University of Washington, Seattle, WA 98195.
Background: Data on the manifestations and optimum management of H1N1 infection in immunocompromised patients are sparse (1, 2).
Objective: To report a case of H1N1-associated pneumonia in a hematopoietic stem-cell transplant recipient with extrapulmonary H1N1 RNA detection who was treated with intravenous peramivir.
Case Report: A woman in her 40s (body mass index, 31.8 kg/m2) with multiple myeloma had outpatient autologous hematopoietic stem-cell transplantation with myeloablative conditioning in May 2009. Two days after transplantation, she was hospitalized with fever, nausea, diarrhea, and minimally productive cough. Chest radiography was normal, neutrophil count was 1.42 ? 109 cells/L, and no lymphocytes were present. Despite receiving empirical broad-spectrum antibiotics, the patient developed increased tachypnea and hypoxia. Chest computed tomography on hospital day 3 showed bilateral ground-glass opacities with central nodules. Nasal swab was positive for influenza A/H1N1 by a real-time RT-PCR assay developed at our center by using primers and a probe targeting a 102?base pair fragment of the hemagglutinin gene.
We initiated therapy with high-dose oseltamivir, 150 mg twice daily, our institution's standard practice for hematopoietic stem-cell ?
This 100-word excerpt has been provided in the absence of an abstract.
1. Angela P. Campbell, MD, MPH;
2. Shevin T. Jacob, MD, MPH;
3. Jane Kuypers, PhD;
4. Anna Wald, MD, MPH;
5. Janet A. Englund, MD;
6. Lawrence Corey, MD; and
7. Michael Boeckh, MD
1.
From University of Washington, Seattle, WA 98195.
Background: Data on the manifestations and optimum management of H1N1 infection in immunocompromised patients are sparse (1, 2).
Objective: To report a case of H1N1-associated pneumonia in a hematopoietic stem-cell transplant recipient with extrapulmonary H1N1 RNA detection who was treated with intravenous peramivir.
Case Report: A woman in her 40s (body mass index, 31.8 kg/m2) with multiple myeloma had outpatient autologous hematopoietic stem-cell transplantation with myeloablative conditioning in May 2009. Two days after transplantation, she was hospitalized with fever, nausea, diarrhea, and minimally productive cough. Chest radiography was normal, neutrophil count was 1.42 ? 109 cells/L, and no lymphocytes were present. Despite receiving empirical broad-spectrum antibiotics, the patient developed increased tachypnea and hypoxia. Chest computed tomography on hospital day 3 showed bilateral ground-glass opacities with central nodules. Nasal swab was positive for influenza A/H1N1 by a real-time RT-PCR assay developed at our center by using primers and a probe targeting a 102?base pair fragment of the hemagglutinin gene.
We initiated therapy with high-dose oseltamivir, 150 mg twice daily, our institution's standard practice for hematopoietic stem-cell ?
This 100-word excerpt has been provided in the absence of an abstract.
