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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr0220102763.
Published online Sep 17, 2010. doi:  10.1136/bcr.02.2010.2763
PMCID: PMC3028931
Novel treatment (new drug/intervention; established drug/procedure in new situation)
Successful management of fulminant influenza A subtype H1N1 myocarditis
Miguel Cobas,1 Lilian Abbo,2 Miguel Santos,1 Clara Baccini-Jauregui,2 and Si Pham3
1Department of Anesthesiology, University of Miami, Miami, Florida, USA
2Department of Infectious Diseases, University of Miami, Miami, Florida, USA
3Department of Surgery, University of Miami, Miami, Florida, USA
Correspondence to Miguel Cobas, cobas/at/
The outbreak and spread of the new influenza A subtype H1N1 reached pandemic levels during 2009, with greater numbers of cases reported daily and numerous complications described. The present report concerns an atypical manifestation of the disease in a previously healthy middle-aged patient who presented with severe, refractory cardiogenic shock 4 days after being diagnosed as having influenza A. The patient was considered for emergency heart transplant. Successful treatment involved the use of a left ventricular assist device, extracorporeal membrane oxygenation, intravenous immunoglobulin and peramivir as therapeutics and bridging therapies for transplant. This case is a report of H1N1 fulminant myocarditis and illustrates the usefulness of a multidisciplinary approach in the care of these patients.
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