Medical Mystery: How did a healthy young man come so close to death?

In the spring of 2016, a man in his early 20s traveled to the United States from West Africa to visit his family. Four days after his arrival, he fell ill and developed a fever, body aches, chills and fatigue. He felt nauseated, had loose stools and frequent urination. After several days, he came to the hospital.

Before all this began, he was healthy and had no past medical complications. He was not taking any medications.

I saw him shortly after he was admitted to our hospital. He appeared extremely ill and appeared to be getting worse. He was lethargic, had a high fever, rapid heart rate and breathing, and clinical signs of decreased blood flow.

Since coming to the U.S., he told me, he mostly stayed indoors with his family, who did not own any pets. He ate all his meals at home with his family, none of whom were ill. To his knowledge, he had not been in contact with anyone who was ill. At the time, Ebola was in the headlines, but no cases had been isolated in his region of Africa.

Interestingly, the rest of his exam was unremarkable. He did not have any abnormal findings in his eyes, ears or mouth, his neck was supple, and his lung and heart sounds were normal. His abdominal exam was benign and he did not have any rashes. His initial blood work and chest X-ray were both also normal.

But that night, his condition worsened. His fever spiked to 105.4, his blood pressure dropped, his respiratory rate went up and his oxygen saturation dropped. There were also new abnormalities in his labs, including anemia, lactic acidosis, decreased platelet and white cell counts. He required intravenous medications to maintain a life-sustaining blood pressure.

Although his chest X-ray upon admission was normal, a repeat X-ray showed signs of a blossoming pneumonia.

Worst of all, he was developing septic shock. We immediately transferred him to the ICU where he required a breathing tube and a ventilator. In the ICU, he developed Adult Respiratory Distress Syndrome (ARDS), an illness caused by severe pneumonia. ARDS causes dramatically decreased oxygen levels due to the small vessels in the lungs leaking more fluid than normal into the lungs' air sacks. He needed blood transfusions due to his anemia. His fevers persisted for several days, and as a result of the sepsis, his kidneys were being damaged.

The ICU staff applied various techniques to improve his oxygenation, but his situation worsened. To save this young patient's life, he was transferred to another hospital where he could get an advanced life support treatment, ECMO (extracorporeal membrane oxygenation). This treatment is provided by a machine to take over the function of the lungs temporarily. The machine cleanses the blood of carbon dioxide and provides oxygen to the blood circulation.

After a long and protracted course, his lung function gradually improved. By the summer, he fully recovered and came back to our ICU with his family and thanked the members of the medical team for saving his life.

What caused this young man to become so desperately ill?

The initial diagnosis in this case was influenza. While he was in the ER, a rapid influenza test was done and the result was positive for Influenza A. A rapid test for malaria was also done as he came from a malaria-endemic region. However, it was negative.

Two days after his admission, and as his condition worsened with severe bilateral pneumonia and septic shock, his sputum – the secretions from his lungs – showed a bacteria called Staphylococcus aureus, which caused his pneumonia.  The influenza virus causes changes in the respiratory tract making patients susceptible to develop bacterial pneumonia, which carries a higher risk of severe infection compared to bacterial pneumonia without a preceding viral illness.

It is important to note that he caught the flu in the spring. Most of us associate flu with the winter, but some flu seasons last longer or simply start later.

My patient acquired the flu shortly after his arrival to the U.S. He had not received the flu vaccine, which could have prevented this devastating illness, or at least lessened his symptoms.

Every year in the U.S. seasonal influenza kills thousands of people. Many more become so ill, they must be hospitalized. Children, elderly and those with chronic medical conditions are more at risk for severe disease, but as my patient's case showed, flu can be serious at any age. So it is extremely important to receive flu vaccines each year to protect ourselves and our loved ones.

Gul Madison, M.D., is an infectious disease specialist at Mercy Philadelphia Hospital.