Rapidly Progressive Lethal Infection With Novel Influenza A (H1N1) 2009 Virus in a Kidney Recipient: A Cautionary Tale

摘要

In June 2009, the World Health Organization declared a pandemic of the novel swine-origin influenza A (H1N1) virus, reflecting the rapid global spread but not the severity of the illness caused by the virus (1). Currently, insufficient data are available to determine who is at high risk for complications of infection with the novel virus (2,3). We report the first known case of lethal infection with novel influenza A (H1N1) virus in a solid organ transplant recipient, highlighting specific aspects of the clinical course that may be relevant for devising prophylactic, diagnostic, and treatment strategies for this particular group of patients. A 68-year-old Latino man (body mass index: 26 kg/m~2) on peritoneal dialysis due to stage V chronic kidney disease from diabetic nephropathy (medical history: diet-controlled type II diabetes, hypertension, hypothyroidism and pneumonia) received a deceased donor renal transplant. The graft functioned immediately; standard induction immunosup-pression consisted of a short 3-day course of intravenous steroids and antithymocyte globulin.