Two severe cases of H7N9 pneumonia patients with immunoneuroendocrine axis dysfunction and vitamin D insufficiency

BACKGROUND The immunoneuroendocrine axis plays a major role in the regulation of the host's response to infection, but its role in severe H7N9 pneumonia is still unknown. Therefore, this study is carried out to explore the relationship between the immunoneuroendocrine axis and severe H7N9 pneumonia. CASE PRESENTANTION The study included two H7N9 pneumonia patients. Endocrine response and cellular immune function in prolonged phase of these two severe H7N9 pneumonia cases were reported and analyzed. A 57-year-old male patient (case 1) and a 68-year-old male patient (case 2) were admitted because of cough, fever and dyspnea. Moist rales were present in both lungs. The rest of the examination was reportedly normal. The laboratory test showed that (1) The patients had loss of cortisol rhythm and elevated cortisol level at 4 pm. (2) The patients showed decline of cellular immune function. (3) The patients showed vitamin D insufficiency. (4) Case 2 had higher cortisol level but lower DHEAS, serum phosphorus and vitamin D level as well as cellular immune function than case 1. (5) The thyroid axis, gonadal and lactotropic axis were normal, so were the level of FT3, FT4, STSH and LH, FSH, T, E2 as well as PRL in these two cases. Chest CT revealed inflammation of both lungs especially in right lung. Real time RT-PCR by Centers for Disease Control and Prevention (CDC) confirmed H7N9 infection. CONCLUSION Immunoneuroendocrine axis dysfunction may play an important role in severe H7N9 pneumonia. We need pay more attention to hypophosphatemia and vitamin D insufficiency in H7N9 pneumonia.