PMC5296325_01
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.
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F1
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).