Pitfalls in Diagnosis of Pandemic (Novel) A/H1N1 2009 Influenza

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Abstract
A 50-year-old male with asthma was admitted to RUMC on 6 July 2009 with a 4-day history of fevers up to 38.9°C, chills, productive cough with mild hemoptysis, and diarrhea for 1 day. He was tachycardic, with a saturation of peripheral oxygen (SpO2) of 96% in room air (RA) and a negative chest X-ray (CXR). Levofloxacin was empirically started. A polyester-tipped nasopharyngeal swab (Puritan Medical Products, Guildford, ME) in M4RT transport medium (Remel, Lenexa, KS) was collected on admission and tested negative for respiratory viruses by Luminex xTag RVP reverse transcription-PCR (RT-PCR; Luminex, Austin, TX) and Centers for Disease Control and Prevention (CDC) novel A/H1N1 RT-PCR performed at the Illinois Department of Public Health (IDPH). The patient had a chest computed tomography (CT) scan that showed bilateral upper-lobe confluent airspace opacities with multiple small lung cysts and scattered micronodules. Bronchoscopy was performed on 10 July which found copious thick clear secretions and scattered hyperemia and airway wall edema throughout both lungs. The BAL fluid sample was positive for pandemic (H1N1) 2009 influenza by both Luminex and CDC RT-PCRs. The patient improved clinically and was discharged without antiviral treatment.