A case study on Novel H1N1.

545 A 51-year-old Caucasian man with a history of acute myeloid leukemia, W.H. is three years removed from an unrelated donor allogeneic stem cell transplantation. W.H. has a significant medication history of post-transplantation antibiotic usage, macrolide immunosuppressant (tacrolimus), steroids, and immunoglobulin G1k monoclonal antibody (infliximab) for chronic graft-versus-host disease (GVHD). He presented to the clinic complaining of rhinorrhea, which he attributed to seasonal allergies; chest discomfort with coughing; sinus pain; and congestion. The patient was febrile (38.6o C), but he denied hemoptysis or discolored sputum. Diagnostic workup included a complete blood count with differential, peripheral, and central venous catheter blood cultures; urine culture; sensitivity; chest x-ray; chest and sinus computed tomography (CT) scan; cytomegalovirus antigenemia; stool for vancomycinresistant Enterococcus; and a nasal wash. Pertinent laboratory results included a positive rapid antigen test for H1N1 (swine-like) virus, low hemoglobin (11.7 g/dl), hematocrit (33%), and platelet count (67,000 cells/mm3). W.H. had elevated segmented neutrophils (80%), creatinine (1.5 mg/dl), aspartate amionotransferase (89 IU/L), and alanine aminotranserase (63 IU/L). Chest x-ray, chest CT, and blood cultures were negative, but a sinus CT revealed trace sinus disease. W.H. was transferred to a protective isolation floor and placed on strict respiratory isolation precautions secondary to a positive test for H1N1 virus. The infectious disease team was consulted because W.H. had a significant history of bacterial, viral, and fungal infections and had recently taken medications that suppressed his immune response (i.e., antivirals and corticosteroids). In addition, W.H.’s white blood cell count remained at low normal levels, often requiring subsequent injections of filgrastim to boost white blood cell production. W.H. A Case Study on Novel H1N1