Successful Outcome in an Adult Patient with Influenza-associated Hemorrhagic Shock and Encephalopathy Syndrome

Abstract

A 50-year-old woman presented with coma and hemorrhagic shock. A rapid influenza antigen test revealed influenza A infection; other laboratory examinations ruled out any other suspected infections. She was diagnosed with hemorrhagic shock and encephalopathy syndrome (HSES) induced by influenza A. She was administered methylprednisolone pulse therapy and peramivir. Subsequently, she was discharged without any sequelae. Only a few cases of influenza-induced HSES have been reported, and the clinical outcomes were very poor. We herein report a successfully treated adult case of influenza-induced HSES and review this rare syndrome.

Keywords: HSES; IAE; hemorrhagic shock and encephalopathy syndrome; influenza; influenza-associated encephalopathy.

Figure 1.

Brain CT findings in pre- and post- treatment. Loss of contrast between gray and white matter and hypodensity demonstrated at acute phase improved on day 5 (A; acute phase, B; recovery phase).

Figure 2.

Clinical course of our patient. The vertical axis shows the level of CRP and horizonal axis shows days after admission. Rectangles above this chart demonstrate medications administered in the patient, and those durations and daily dosages. Several hours after admission, she developed coma, which required endotracheal intubation. On day 4, she opened her eyes in response to our voices. She could obey our commands on day 5 and was extubated on day 6. Massive gastrointestinal hemorrhage occurred only on admission and diarrhea ensued for 7 days.