Fulminant Myocarditis Due to H1N1 Influenza

We report 2 cases of fulminant myocarditis caused by the H1N1 strain of influenza. As the incidence of H1N1 influenza infection continues to rise, physicians should be aware of this rare and potentially fatal complication because early diagnosis and aggressive supportive measures are imperative. A 52-year-old woman presented with a 3-day history of chest pain, dyspnea, diffuse myalgias, and fever. The ECG demonstrated low voltage with diffuse ST segment elevation (Figure 1). The troponin I was 5 ng/mL (0 to 0.75 ng/mL), and B-type natriuretic peptide was 1629 pg/mL (0 to 100 pg/mL). The patient was transferred to our facility for urgent left heart catheterization. On presentation, her blood pressure was 87/50 mm Hg. Coronary angiography demonstrated normal coronary arteries. Dopamine was started for blood pressure support. The patient was treated with oseltamivir 150 mg twice a day and IV ceftriaxone for suspected viral and/or bacterial myocarditis and pneumonitis. A transthoracic echocardiogram demonstrated global left ventricular systolic dysfunction with an ejection fraction of 29% and a trivial pericardial effusion. Blood cultures and rapid influenza A and B antigen tests were negative. On …