Acus Kirstin, Meigher Stephen, Saggar Vinay
Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, USA.
Cureus. 2024 Apr 7;16(4):e57778. doi: 10.7759/cureus.57778. eCollection 2024 Apr.
Influenza most often causes a febrile viral syndrome inclusive of pulmonary irritation with cough, shortness of breath, and congestion. However, severe infection can also occur, causing significant viral pneumonia with Type 1 respiratory failure. and rare but life-altering complications such as pneumomediastinum, secondary bacterial pneumonia, acute respiratory distress syndrome (ARDS), viremia, and death. This was a case of a 20-year-old male with no significant past medical history who presented to the emergency department with shortness of breath and chest discomfort and was found to have Influenza A with Type I respiratory failure requiring High Flow Nasal Cannula (HFNC) and extensive pneumomediastinum, superimposed bacterial pneumonia, and bilateral pneumothoraces. It is possible that complications secondary to influenza A infections could be under-reported due to the extremely high prevalence of the viral infection in this country. In addition, complicated pneumomediastinum from Influenza infection is sparsely documented in young adult males and children, but its clinical course can be dramatic enough to include life-altering complications. This case should serve as a reminder to all emergency medicine providers that when evaluating unstable Influenza A patients, various tests should be considered on a case-by-case basis to risk-stratify the likelihood of emergent pathology.
流感最常引起发热性病毒综合征，包括伴有咳嗽、呼吸急促和充血的肺部刺激症状。然而，也可能发生严重感染，导致严重的病毒性肺炎并伴有I型呼吸衰竭，以及罕见但会改变生活的并发症，如纵隔气肿、继发性细菌性肺炎、急性呼吸窘迫综合征（ARDS）、病毒血症和死亡。这是一例20岁男性患者，既往无重大病史，因呼吸急促和胸部不适就诊于急诊科，被诊断为甲型流感伴I型呼吸衰竭，需要使用高流量鼻导管（HFNC）治疗，同时伴有广泛的纵隔气肿、叠加的细菌性肺炎和双侧气胸。由于该国病毒感染的极高流行率，甲型流感感染继发的并发症可能未得到充分报告。此外，流感感染导致的复杂性纵隔气肿在年轻成年男性和儿童中记录较少，但其临床过程可能非常严重，足以包括改变生活的并发症。该病例应提醒所有急诊医学从业者，在评估不稳定的甲型流感患者时，应根据具体情况考虑进行各种检查，以对紧急病变的可能性进行风险分层。
