Why can flu be so deadly? An unusual case of cardiogenic shock

During the following days, hemodynamic parameters and biventricular function (monitored by serial TTE and TEE) improved without neurological complications. Cardiac, renal, liver and muscle damage markers began to decline. Blood and pericardial effusion cultures resulted negative, on the contrary, a nasal swab resulted positive for influenza B virus by polymerase chain reaction. The patient was weaned from ECLS on day 5th. After demonstration of full recovery of biventricular function, IABP was removed on day 7th. Due to prolonged time of mechanical ventilation the patient required surgical tracheostomy. After proper respiratory training and improvement of clinical conditions, he was finally weaned from mechanical ventilation on day 20th. An Acinetobacter baumanii superinfection was successfully treated with colistin and tigecycline. CRRT was needed for 13 days. Once the patient was in a stable clinical status, he underwent a contrast-enhanced cardiac magnetic resonance (CMR) showing diffuse enhancement on T2-STIR sequences, suggestive of interstitial oedema, affecting both ventricles, especially anterior and lateral walls of left ventricle (Fig. 3). These findings were suggestive of acute myocarditis. After 6 months, another cardiac magnetic resonance was performed and showed complete resolution of interstitial oedema, without demonstration of LGE pattern. The patient was transferred to a rehabilitation centre on day 30th.