Novel 2009 H1N1 influenza virus infection requiring extracorporeal membrane oxygenation in a pediatric heart transplant recipient

The novel 2009 H1N1 influenza virus has been reported to have increased severity in patients with underlying cardiovascular and lung disease. Pediatric patients also appear to have an increased incidence of infection. The impact on cardiothoracic transplant recipients, especially in pediatric recipients, has not been established. We report the case of a 12-year-old boy with history of congenital heart disease who was transplanted in June 2001. In October 2009, it was found that he had developed severe acute respiratory distress syndrome (ARDS) secondary to novel 2009 H1N1 influenza virus. Extracorporeal membrane oxygenation (ECMO) was given as support. Importantly, the initial specimen evaluated by real-time reverse transcriptase–polymerase chain reaction was negative for novel 2009 H1N1 influenza virus. The patient was successfully weaned from ECMO after 24 days, extubated at 6 weeks, and continues to make steady rehabilitative progress. Early suspicion for infection and initiation of treatment, even with negative testing, is essential for cardiothoracic transplant recipients during the current pandemic of novel 2009 H1N1 influenza virus.

Keywords: influenza, heart transplantation (pediatric), extracorporeal membrane oxygenation (ECMO), acute respiratory distress syndrome (ARDS), brochoalveolar lavage (BAL) or bronchoscopy, pneumonia, reverse transcriptase polymerase chain reaction (PCR)