A Fatal Case of Acute Myocardial Infarction following the Improvement of Influenza A(H1N1)pdm2009-related Acute Myocarditis

A 52-year-old Indian man was hospitalized due to dyspnea and a high fever caused by influenza A(H1N1)pdm2009. Elevated cardiac enzymes, a chest X-ray showing bilateral infiltrative shadows, cardiomegaly and pleural effusion and echocardiography indicating diffuse hypokinesis of the left ventricle suggested cardiac failure due to acute myocarditis. Owing to the administration of combined modality therapy, including steroids and intravenous γ-globulin, the patient's clinical symptoms of influenza completely resolved. However, he suddenly complained of epigastric pain due to acute myocardial infarction and died. This report is an educational case, the results of which suggest that greater attention should be paid to the potential for myocardial infarction even after an influenza virus infection is found to improve.