This virology case involves a 13-year-old male patient in New Mexico who had a medical history significant for asthma. During a routine physical exam administered by his primary care physician, he was diagnosed with a sore throat and given a Z-pack. Several days later, the patient returned to the doctor’s office with complaints of pain during inhalation. The doctor gave him a prescription for nebulizer treatment to be administered every four hours. When the patient took the first treatment, his chest was hurting. A few days later, the patient presented to the emergency room where he was diagnosed with pneumonia. Doctors did not change his medications at that time and he was discharged. He was taken back to hospital two days later, where he was prescribed 8 tablets of polymedrol and hydrocodone and was released home. On Monday, the patient was complaining of pain in his upper back and his blood oxygen was lower. He was taken back to the hospital, where an IV was started and blood was drawn. The patient’s blood pressure and cardiac rate were low, and it was soon discovered that he was in septic shock and had sustained a prolonged infection. After languishing in the hospital for several days, the patient died. The Medical Examiner’s Office determined that the patient suffered from acute viral pneumonia and the influenza B virus, which was complicated by an acute asthma exacerbation.
Question(s) For Expert Witness
- 1. Do you treat patients similar to the one described in the case?
- 2. Have you ever had a patient develop the outcome described in the case?
- 3. What could have been done for the patient to avoid such an outcome?
Expert Witness Response E-007322
I am glad to assit with this case. I’ve seen viral pneumonia hundreds of times. This is not typical with an immunocompetent 13 year old, asthma or not. Secondary bacterial pneumonia happens quite often with influenza. From the limited history presented above, it seems that they focused on his asthma and never started him on any antibiotic since the z-pack the week before, which he likely finished a least a few days before this illness started. His signs and symptoms were never going to improve without treating the secondary pneumonia. It also looks like they never started steroids orally or by IM/IV. If they were sure this was all flu and asthma then oral steroids would have been a logical choice somewhere in this course. It wouldn’t have treated the pneumonia, but it would have helped his asthma.
Expert Witness Response E-007428
I am a board certified pediatric emergency physician with 20 years of clinical experience. I am also an Associate Professor of Pediatrics at the Medical University where I work. I have treated many pediatric patients with Influenza. I have also treated many cases of septic shock and have led many resuscitations of critically ill children. Influenza is known to be more severe in children with Asthma. The CDC (the Centers for Disease Control) recommend treating children diagnosed with influenza with an antiviral medication called Tamiflu. It is thought that early institution of this medication may lesser the severity of the disease and decrease complications such as pneumonia or sepsis. From reviewing the case, I think it likely that this child developed one of these complications. If the health care providers had diagnosed influenza early in the illness and started Tamiflu, his deterioration may have been prevented.