Respiratory failure due to novel 2009 pandemic A/H1N1 influenza in a chronic hemodialysis patient

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  • 呼吸不全を呈した新型インフルエンザ（Ａ／Ｈ１Ｎ１ｐｄｍ）感染血液透析患者の１例
  • 症例報告 呼吸不全を呈した新型インフルエンザ(A/H1N1pdm)感染血液透析患者の1例
  • ショウレイ ホウコク コキュウ フゼン オ テイシタ シンガタ インフルエンザ A H1N1pdm カンセン ケツエキ トウセキ カンジャ ノ 1レイ

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Abstract

A 73-year-old man with end-stage renal disease undergoing hemodialysis treatment visited our emergency room because of fever and a sore throat. He had a history of encapsulating peritoneal sclerosis, for which he received corticosteroid treatment, and had cardiac disease. A rapid detection test for influenza virus showed a positive result for A antigen, and so acetoaminophen and oseltamivir were administered. The patient was admitted the next day because of dyspnea, persistant fever, and anorexia. He was febrile, with pulse oxygen saturation of 78% in room air. Computed tomography of the chest showed bilateral multifocal consolidation involving all lobes and bilateral pleural effusion. He was treated with zanamivir, prednisone, and emergent hemodialysis. Subsequently, respiratory failure improved and the abnormal lung shadows disappeared after 5 days. Novel A/H1N1 viral RNA was detected in the patient's sputum specimen using the real-time reverse transcriptase-polymerase chain reaction. Novel influenza infections in dialysis patients have included lower repiratory disease, resulting in respiratory failure. Clinicians should be aware that severe novel A/H1N1 influenza infection can occur in hemodialysis patients with high-risk factors.

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