Myocarditis complicating H1N1 pneumonia: Case report and literature review
More details
Hide details
7th Pulmonology Department and Asthma Center, Athens Chest Hospital, Greece
Cardiology Department, Athens Chest Hospital, Greece
Metropolitan Hospital, Greece
Radiology Department, Athens Chest Hospital, Greece
Likurgos Kolilekas   

7th Pulmonary Department, Athens Chest Hospital "Sotiria", 152 Mesogion Ave, 11527, Athens, Greece
Publication date: 2021-06-17
Pneumon 2016;29(1):78–83
These authors have equally contributed to this work.

Influenza infection most commonly affects the upper and lower respiratory tracts, but can involve also extrapulmonary sites, including the myocardium. We report a case of a previously healthy adult diagnosed with pneumonia complicated with myocarditis caused by H1N1 influenza virus, and we review the literature on influenza myocarditis. The patient was male, 37 years old, and presented in the emergency department on January this year, with fever, pleuritic chest pain and shortness of breath of ten days duration. Chest X-ray and CT-scan findings depicted bilateral infiltrates compatible with severe pneumonia and the test for H1N1 in nasopharyngeal secretions was positive for H1N1. Because of elevated cardiac enzymes and abnormal electrocardiograph (ECG), myocarditis was suspected and finally confirmed by Cardiac Magnetic Resonance (CMR). We concluded that myocarditis of various severity is an unusual and potentially fatal complication of H1N1 infection and high level of clinical suspicion is essential for timely diagnosis and treatment.
All the authors declare that they do not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.
Ruuskanen O, Lahti E, Jennings LC, et al. Viral pneumonia. Lancet 2011;377:1264-75.
CS Joint Working Group. Guidelines for diagnosis and treatment of myocarditis (JCS, 2009). Circ J 2011;75:734-43.
Mamas MA, Fraser D, Neyses L. Cardiovascular manifestations associated with influenza virus infection. Int J Cardiol 2008;130:304-9.
The World Health Organization. The global burden of disease: 2004 update. Switzerland: Work Health Organization; 2008. Available at: Accessed April 8, 2016.
Tsiodras S. Influenza pandemic: Is there a real threat? Pneumon 2009;22:211-2.
Onitsuka H, Imamura T, Miyamoto N, et al. Clinical manifestations of influenza a myocarditis during the influenza epidemic of winter 1998-1999. J Cardiol 2001;37:315-23.
Ukimura A, Izumi T, Matsumori A; Clinical Research Committee on Myocarditis Associated with the 2009 Influenza A (H1N1) Pandemic in Japan organized by the Japanese Circulation Society. A National Survey on Myocarditis Associated with the 2009 Influenza A (H1N1) Pandemic in Japan. Circ J 2010;74:2193-9.
Bratincsák A, El-Said HG, Bradley JS, et al. Fulminant myocarditis associated with pandemic H1N1 influenza A virus in children. JACC 2010;55:926-33.
Cunha B, Syed U, Mickail N. Fulminant fatal swine influenza (H1N1): myocarditis, myocardial infarction, or severe influenza pneumonia? Heart Lung 2010;39:453-8.
Khouzam R, Parizianu C, Hafiz A, et al. Fulminant myocarditis associated with novel H1N1 influenza A. Heart Lung 2011;40:566-8.
Weiss T, Knut H, Stensaeth K, et al. Myocarditis in a juvenile patient with influenza A virus infection. Eur Heart J 2010;31:277.
Penela D, Regueiro-Cueva A, Ortiz-Pιrez JT, et al. Myocarditis due to pandemic influenza A (H1N1). Rev Esp Cardiol 2010;63:1386-7.
Al-Ammodi M, Rao K, Rao S, et al. Fulminant myocarditis due to H1N1 influenza. Circ Heart Fail 2010;3:7-9.
Vila de Muga M, Torre Monmany N, Asensio Carretero S, et al. Caracteristicas clinicas de la gripe A H1N1 2009: estudio multicentrico. An Pediatr 2011;75:6-12.
Cabral M, Brito MJ, Conde M, et al. Fulminant myocarditis associated with pandemic H1N1 influenza A virus. Rev Port Cardiol 2012;31:517-20.
Komai T, Nakazawa G, Asai S, et al. Fatal fulminant myocarditis associated with novel influenza A (H1N1) infection. Eur Heart J 2011;32:283.
CS JointWorking Group. Guidelines for diagnosis and treatment of myocarditis (JCS, 2009): digest version. Circ J 2011;75:734-43.
Hiramitsu S, Morimoto SI, Kato S, et al. Transient ventricular wall thickening in acute myocarditis: a serial echocardiographic and histopathologic study. Jpn Circ J 2001;65:863-6.
Erden I, Erden EC, Ozhan H, et al. Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza A virus. Cardiol J 2011;18:552-5.
Sahin DY, Demir M, Kurtaran B, et al. A case of myocarditis mimicking acute coronary syndrome associated with H1N1 influenza A virus infection. Turk Kardiyol Dern Ars 2010;38:572-5.
Mavrogeni S, Manoussakis MN. Myocarditis as a complication of influenza A (H1N1): Evaluation using cardiovascular magnetic resonance imaging. Hellenic J Cardiol 2010;51:379-380.
Lv S, Rong J, Ren S, et al. Epidemiology and Diagnosis of Viral Myocarditis. Hellenic J Cardiol 2013;54:382-91.
HA Central Committee on Infectious Disease and Emergency Responses (CCIDER). Interim guideline on antiviral treatment, chemoprophylaxis and pneumococcal vaccination for human swine influenza/influenza A (H1N1) Infection. 21 Oct 2009. Available at:
CDC. Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season. Available at: Accessed April 8, 2016.