Abstract While Influenza A is usually self-limiting, the 2024-2025 flu season was marked by unusual severity with increased complications including systemic inflammation, acute respiratory distress syndrome (ARDS), and fulminant myocarditis even in previously healthy adults. Early recognition and aggressive management, including ventilatory support and extracorporeal membrane oxygenation (ECMO) are critical. Unfortunately, prognosis remains poor when complicated by neurologic injury and multisystem organ failure as this case illustrates. A 45-year-old man with chronic cigarette use presented with respiratory distress after several days of fever, cough, and bloody sputum. He had visited the ED but left without being seen. He returned in respiratory distress requiring BiPAP initiation followed by intubation before confirmed to have Influenza A. Further workups revealed superimposed MRSA necrotizing pneumonia and ARDS with P:F ratio of 110. Shortly after, he experienced two cardiac arrests and hypoxemia despite maximal ventilator support necessitating initiation of venous-venous ECMO. His hospital course was complicated by hemodynamic instability and cardiogenic shock requiring vasopressors with inotropes. Coronary angiography revealed a 99% occluded proximal LAD lesion, and an Impella CP device was placed for mechanical support. Additional complications included renal failure requiring continuous renal replacement therapy (CRRT), severe thrombocytopenia, and atrial fibrillation. Although decannulated on hospital day 7, he developed a right sided pneumothorax that required chest tube placement. Despite interventions, he continued to deteriorate with refractory shock, hypoxemia, and succumbed to multisystem organ failure. This case underscores the potential of Influenza A to trigger superimposed infections and systemic illness, especially in patients with delayed care and risk factors such as smoking even without other medical comorbidities. While VV-ECMO and Impella CP led to transient stabilization, the extent of systemic involvement ultimately resulted in death. Early recognition of secondary infection, intervention, and escalation to mechanical circulatory support are vital but unfortunately not always sufficient in fulminant cases. This abstract is funded by: None
Kalaycioglu et al. (Fri,) studied this question.