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

Letters4 May 2010Respiratory Failure Caused by 2009 Novel Influenza A/H1N1 in a Hematopoietic Stem-Cell Transplant Recipient: Detection of Extrapulmonary H1N1 RNA and Use of Intravenous PeramivirAngela P. Campbell, MD, MPH, Shevin T. Jacob, MD, MPH, Jane Kuypers, PhD, Anna Wald, MD, MPH, Janet A. Englund, MD, Lawrence Corey, MD, and Michael Boeckh, MDAngela P. Campbell, MD, MPHFrom University of Washington, Seattle, WA 98195.Search for more papers by this author, Shevin T. Jacob, MD, MPHFrom University of Washington, Seattle, WA 98195.Search for more papers by this author, Jane Kuypers, PhDFrom University of Washington, Seattle, WA 98195.Search for more papers by this author, Anna Wald, MD, MPHFrom University of Washington, Seattle, WA 98195.Search for more papers by this author, Janet A. Englund, MDFrom University of Washington, Seattle, WA 98195.Search for more papers by this author, Lawrence Corey, MDFrom University of Washington, Seattle, WA 98195.Search for more papers by this author, and Michael Boeckh, MDFrom University of Washington, Seattle, WA 98195.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-9-201005040-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...References1. Lapinsky SE. H1N1 novel influenza A in pregnant and immunocompromised patients. Crit Care Med. 2009. [PMID: 19935415] MedlineGoogle Scholar2. Casper C, Englund J, Boeckh M. How I treat influenza in patients with hematologic malignancies. Blood. 2010;115:1331-42. [PMID: 20009037] CrossrefMedlineGoogle Scholar3. Campbell AP, Chien JW, Kuypers J, Englund JA, Wald A, Guthrie KA, et al. Respiratory virus pneumonia after hematopoietic cell transplantation (HCT): associations between viral load in bronchoalveolar lavage samples, viral RNA detection in serum samples, and clinical outcomes of HCT. J Infect Dis. 2010;201:1404-13. CrossrefMedlineGoogle Scholar4. Kuiken T, Taubenberger JK. Pathology of human influenza revisited. Vaccine. 2008;26 Suppl 4 D59-66. [PMID: 19230162] CrossrefMedlineGoogle Scholar5. Gooskens J, Jonges M, Claas EC, Meijer A, Kroes AC. Prolonged influenza virus infection during lymphocytopenia and frequent detection of drug-resistant viruses. J Infect Dis. 2009;199:1435-41. [PMID: 19392620] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Washington, Seattle, WA 98195.Note: Drs. Campbell and Jacob contributed equally to this article.Acknowledgment: The authors thank Christi Dahlgren and Deborah Reyes for assistance compiling clinical and laboratory data; Anne Cent, Nancy Wright, Patricia Nguyen for specimen processing, testing, and laboratory expertise; and Debra Mattson for critical review of the manuscript. Biocryst Pharmaceuticals provided peramivir under emergency investigational new drug status.Grant Support: By the National Institutes of Health (grants CA18029, HL081595, K23HL091059, L40AI071572, K24AI071113, and K24HL093294).Disclosures: Dr. Campbell has received grant support from MedImmune. Dr. Jacob received grant support from Pfizer. Dr. Wald received grant support from Roche Pharmaceuticals and GlaxoSmithKline. Dr. Englund has received grant support from MedImmune, Adamas Pharmaceuticals, and Novartis. Dr. Boeckh received grant support from Adamas Pharmaceuticals and Roche Pharmaceuticals, is a consultant for Roche and Novartis, and has received speaking fees from Roche. 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