Wednesday, November 4, 2009

Glad I got my vaccine

Just saw this case on the pathology rotation:

A slightly overweight, otherwise healthy 50ish year-old man, 5 days ago starts feeling tired and gets a slight fever (~100 F). He goes on a trip with some friends and returns 2 days later. At that point he is feeling much more tired, his muscles ache a bit, he is starting to get short of breath and his fever is a bit worse (~102 F). He goes to the local ER where they think he might have H1N1 and because of his worsening shortness of breath he is admitted. Over the next day his condition dramatically worsens. He is intubated, his fever skyrockets (~109 F (!)) and he is transferred to a larger hospital. He dies within 12 hours of arriving at the larger hospital. He is determined to be H1N1 positive.

On autopsy, except for his lungs, all his organs show no signs of any disease or abnormality. His lungs, however, weigh about 1200 and 1300 grams each (normal, i think, is about 450 and 500 grams for left and right lungs). It has multiple areas of necrosis, hemorrhage and consolidation (like a really, really bad pneumonia). What goes beyond a normal pneumonia is that it covers the entirety of both lungs (ARDS) and even goes up the airway to the trachea, which also shows inflammation and hemorrhage.



  1. I'm glad you got the vaccine, too. Especially because you are also a slightly overweightish man of 50. On a pathology rotation. ;-)

    I came out of an H1N1 room the other day (patient still alive, mind you...), as well, one who had been coughing like there was no tomorrow with fevers spiking at 102-104, and my resident looked over to me after we left the room and said, "I think we both just caught H1N1." Thank heavens for that vaccination, indeed!

  2. Yep, and the resident that I work with was home today (and probably for the rest of the week) with H1N1... he shouldn't have kept on delaying getting that vaccine.

  3. Holy crap! The health care workers end up being the greater risk than the patients. And hopefully you've got somebody else you can work with in the meantime...

  4. Nope, I run the pathology department now!

  5. I just read your reply to a post on Scienceblogs...about vaccines and lung effects on Terra Sig.......I keep hearing about this phenomenom and I wonder what the heck.....I JUST got my H1N1 shot YESTERDAY, and am out of school for the nex few weeks, and Christmas is going to be pretty quiet, so I am thinking that I am preparing for the January wave of this thing. We have had SOOO many kids off of school earlier , some hospitalized, and staff have been getting really sick for up to a week and a half, and the conversation STILLLLLLL is on the safety of the vaccine. I don't get it. Could you point me to a picture of H1N1 lungs, or even something that LOOKS like it so that I can send it out to people I truly do care about? Thank you sooooooo much!

  6. Showing real H1N1 lungs to people who are afraid of the vaccine is a good idea, Anon. I didn't take any photos of the case I was involved in, but it looked something like this (though this may not be a H1N1 lung).