# A Critically Ill Influenza A-Positive Patient With Spontaneous Pneumomediastinum, Superimposed Bacterial Pneumonia, and Bilateral Pneumothoraces

## TL;DR

A young man with no prior health issues developed severe complications from Influenza A, including lung and chest issues requiring urgent care.

## Contribution

This case highlights under-recognized severe complications of Influenza A in young adults, emphasizing the need for thorough evaluation.

## Key findings

- A 20-year-old male with Influenza A developed pneumomediastinum, bacterial pneumonia, and pneumothoraces.
- Severe complications from Influenza A may be under-reported, especially in young adults and children.
- Emergency providers should consider extensive testing for unstable Influenza A patients to detect life-threatening conditions.

## Abstract

Influenza most often causes a febrile viral syndrome inclusive of pulmonary irritation with cough, shortness of breath, and congestion. However, severe infection can also occur, causing significant viral pneumonia with Type 1 respiratory failure. and rare but life-altering complications such as pneumomediastinum, secondary bacterial pneumonia, acute respiratory distress syndrome (ARDS), viremia, and death. This was a case of a 20-year-old male with no significant past medical history who presented to the emergency department with shortness of breath and chest discomfort and was found to have Influenza A with Type I respiratory failure requiring High Flow Nasal Cannula (HFNC) and extensive pneumomediastinum, superimposed bacterial pneumonia, and bilateral pneumothoraces. It is possible that complications secondary to influenza A infections could be under-reported due to the extremely high prevalence of the viral infection in this country. In addition, complicated pneumomediastinum from Influenza infection is sparsely documented in young adult males and children, but its clinical course can be dramatic enough to include life-altering complications. This case should serve as a reminder to all emergency medicine providers that when evaluating unstable Influenza A patients, various tests should be considered on a case-by-case basis to risk-stratify the likelihood of emergent pathology.