Necrotizing tracheobronchitis causing airway obstruction complicated by pandemic 2009 H1N1 influenza: A case report

Abstract

Rationale: Influenza is an infection caused by the influenza virus, and its symptoms are mostly mild and self-limiting. However, influenza can cause severe or fatal complications in high-risk patients. Although tracheobronchitis is one of the common complications of influenza, necrotizing tracheobronchitis is very rare. Herein, we describe a case of necrotizing tracheobronchitis causing airway obstruction complicated by pandemic 2009 H1N1 influenza.

Patient concerns: A 60-year-old man presented with fever and dyspnea. On arrival at the emergency room (ER), the patient received oxygen 4 L/minute via a nasal prolong owing to mild hypoxemia. And invasive mechanical ventilation was needed 5 hours after arrival at the ER due to progressive hypoxemia.

Diagnoses: Fiberoptic bronchoscopy was performed owing to bloody secretion in the endotracheal tube and revealed diffuse tracheobronchitis with necrotic and hemorrhagic materials obstructing the trachea and bronchus. The pandemic 2009 H1N1 influenza virus was detected from the bronchial washing sample; no other microorganism was detected.

Intervention: He received peramivir plus oseltamivir and broad-spectrum antibiotics.

Outcomes: The bloody secretion continued. He developed cardiac arrest due to airway obstruction on the 6th day of admission. After cardiac arrest, his condition progressed to multi-organ failure, and the patient died on the 10th day of admission.

Lessons: We suggest that necrotizing tracheobronchitis be considered in patients with influenza who present with unexplained hypoxemia.

Figure 1

Initial chest radiograph and CT. (A) Chest radiograph at emergency room arrival. (B) Chest CT showing centrilobular nodules with linear branching opacities and confluent consolidation in both the lungs. CT = computed tomography.

Figure 2

Bronchoscopy. Bronchoscopy showing necrotic mucosal changes with hemorrhagic materials and pseudomembranous changes in carina and bronchus intermedius.

Figure 3

Chest radiography after cardiac arrest. Chest computed tomography showing massive materials in the trachea and both bronchi and no interval changes in centrilobular nodules with confluent consolidation in both the lungs. Arrow: endobronchial materials in both the bronchial trees.