Severe influenza A–MSSA necrotizing pneumonia in early pregnancy complicated by pregnancy loss and requiring VV-ECMO: a case report

The co-infection of influenza A with methicillin-susceptible Staphylococcus aureus (MSSA) during pregnancy represents a particularly virulent clinical scenario. Although extracorporeal membrane oxygenation (ECMO) has been used in severe respiratory failure, the complete clinical spectrum—encompassing necrotizing airway obstruction and life-threatening abdominal hemorrhage during ECMO support, particularly in patients who experience first-trimester pregnancy loss—remains poorly characterized. A 33-year-old woman at 8 weeks of gestation presented with influenza A and secondary MSSA pneumonia. One day prior to admission, she experienced a spontaneous miscarriage. Her condition rapidly deteriorated into severe pneumonia, septic shock, and multi-organ dysfunction, ultimately requiring VV-ECMO and renal replacement therapy. Empirical therapy with vancomycin and meropenem (selected due to penicillin/cephalosporin allergy) and oseltamivir was initiated. During the ECMO course, the patient developed necrotic airway obstruction with hemorrhage, necessitating repeated bronchoscopic intervention, and subsequently experienced a life-threatening abdominal hemorrhage that was successfully managed by transcatheter embolization. Despite these severe complications, she was successfully weaned from all forms of organ support and made a full recovery. This case demonstrates that aggressive, multidisciplinary intensive care management, including ECMO, bronchoscopy, and interventional radiology, can result in full recovery in a patient with severe viral-bacterial pneumonia complicated by multi-organ failure.