When the heart gets the flu: Fulminant influenza B myocarditis: A case-series report and review of the literature

• Published in: Journal of critical care Vol. 47; pp. 61 - 64
• Main Authors: Hékimian, Guillaume, Jovanovic, Tamara, Bréchot, Nicolas, Lebreton, Guillaume, Leprince, Pascal, Trouillet, Jean-Louis, Schmidt, Matthieu, Nieszkowska, Ania, Besset, Sébastien, Chastre, Jean, Combes, Alain, Luyt, Charles-Edouard
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.10.2018
• Subjects: Abdomen; Antiviral drugs; Blood pressure; Cardiac arrhythmia; Critical care; Dyspnea; Electrocardiography; Extracorporeal membrane oxygenation; Failure; Fever; Heart; Influenza; Pain; Patients; Renal replacement therapy; Sinuses; Ultrasonic imaging; Viruses; Myocarditis; Extracorporeal membrane oxygenation; Cardiogenic shock; Influenza; Mechanical circulatory support
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2018.06.001

To describe patients with refractory cardiogenic shock related to influenza B virus myocarditis rescued by venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO). Consecutive patients hospitalized in our unit for influenza-associated myocarditis were prospectively included. We also conducted a systematic MEDLINE database literature review through the PubMed search engine, between 1946 and 2017. We report the cases of 4 young patients with fulminant myocarditis requiring VA-ECMO for 6 [5-8] days. Influenza B virus was detected in all patients, either in nasopharyngeal sampling or bronchoalveolar lavage fluid. The 4 patients received oseltamivir. Heart function recovery allowed ECMO device removal without cardiac sequelae in all 4 patients. Systematic review retrieved 184 cases of influenza-associated myocarditis, most cases associated with H1N1 type-A infection during the 2009 pandemic. Forty eight cases of influenza myocarditis-associated cardiogenic shock requiring mechanical circulatory support including 3 cases due to influenza B virus were described. Mean duration of mechanical circulatory support was 8.5 ± 6 days and mortality rate was 33%. Influenza myocarditis is a rare but reversible cause of cardiogenic shock amenable to VA-ECMO rescue. Early antiviral therapy and ECMO support should be considered for patients with fulminant myocarditis during an influenza epidemic.