新型インフルエンザの罹患により死亡した1例

A Fatal Case Induced by the 2009 Pandemic Influenza A/H1N1 Viral Infection

要旨　新型インフルエンザ(パンデミックH1N12009)が流行していた地域で健康であった13歳の女性に頭痛，発熱が出現したため，近医を受診した．簡易検査でインフルエンザAの診断を受け，ザナミビルを処方された．第4病日に症状が悪化し，死亡した．剖検は得られなかった．経過中に胸痛の出現，来院時の検査データで心筋逸脱酵素の上昇を認めたため，臨床診断は劇症型心筋炎による死亡とした．しかし，胸部X線上，肺野の透過性の低下を認めていることから肺胞損傷による急性呼吸不全や臨床経過から脳症の可能性もある．

　In 2009, in a place where the 2009 pandemic influenza A was prevalent, a thirteen-year-old healthy female with headache and fever received the diagnosis of influenza A at a nearby medical facility after a rapid antigen test. Her medical condition deteriorated and she died on the 4th day. Autopsy was not carried out. As she complained of chest pain during the clinical course and a biochemical analysis of blood on arrival demonstrated an increase of creatine kinase MB, we diagnosed her as a case of fluminant myocarditis. However, her chest roentgen demonstrated bilateral cloudiness in the lung fields, so the possibility of acute respiratory distress syndrome due to alveolar damage or encephalopathy remained.