CRA37 WHEN THE FLU TURNS BLOODY: A RARE COMPLICATION OF INFLUENZA PNEUMONIA

G Perumal1, UN Daut2, T Abdul Aziz2
1 University Putra Malaysia, Serdang, Selangor, Malaysia
2 Hospital Sultan Abdul Aziz Shah, Serdang, Selangor, Malaysia

Introduction

Diffuse alveolar hemorrhage (DAH) is recognized as a fatal complication of various respiratory infections, including influenza A pneumonia. This case report presents a patient who developed DAH with influenza A pneumonia.

Case report

A 51-year-old male, chronic smoker for 30 pack years with underlying Type 2 Diabetes Mellitus (DM), Hypertension (HPT), dyslipidemia, and stable Ischemic Heart Disease (IHD) presented with complaints of fever, cough, and pleuritic chest pain for 1 week. Clinical examination revealed respiratory distress with crackles in bilateral lungs. Investigations showed raised inflammatory markers, bilateral alveolar infiltrates in chest radiograph, ground glass opacities, interstitial thickening in CECT thorax and confirmed  influenza A from the respiratory panel.  Acute on Chronic Kidney Disease (CKD) and transient atrial fibrillation (AF) were identified, indicating sepsis-induced nephropathy and cardiac involvement. The patient's condition complicated by diffuse alveolar hemorrhage. Despite this complex clinical picture, the patient responded favorably to a treatment regimen including antivirals, antibiotics, low-dose corticosteroids, and comprehensive supportive care. 

Discussion

Diffuse alveolar hemorrhage (DAH) is a potentially lethal complication of influenza A pneumonia, presenting diagnostic hurdles. Patients with DAH may exhibit cough, dyspnea, and hemoptysis, with bilateral infiltrates and anemia. Early identification is critical due to high mortality rates. Management focuses on supportive care, addressing underlying etiology, and potential corticosteroid use, though optimal use remains debated. A high index of suspicion, particularly in high-risk patients (obese, diabetic, smokers), and timely intervention with antivirals, steroids, and supportive measures can improve outcomes in this condition. 

Conclusion

This case emphasizes the importance of prompt diagnosis and aggressive treatment for influenza A pneumonia, even in high-risk individuals with significant comorbidities.