• Jinsun Chang, Tae-Ok Kim, Joon-Young Yoon, Bo-Gun Kho, Hong-Joon Shin, Yong-Soo Kwon, Yu-Il Kim, and Sung-Chul Lim.
• Department of Internal Medicine, Mokpo Hankook Hospital, Jeollanamdo.
• Medicine (Baltimore). 2020 Jan 1; 99 (1): e18647.

RationaleInfluenza is an infection caused by the influenza virus, and its symptoms are mostly mild and self-limiting. However, influenza can cause severe or fatal complications in high-risk patients. Although tracheobronchitis is one of the common complications of influenza, necrotizing tracheobronchitis is very rare. Herein, we describe a case of necrotizing tracheobronchitis causing airway obstruction complicated by pandemic 2009 H1N1 influenza.Patient ConcernsA 60-year-old man presented with fever and dyspnea. On arrival at the emergency room (ER), the patient received oxygen 4 L/minute via a nasal prolong owing to mild hypoxemia. And invasive mechanical ventilation was needed 5 hours after arrival at the ER due to progressive hypoxemia.DiagnosesFiberoptic bronchoscopy was performed owing to bloody secretion in the endotracheal tube and revealed diffuse tracheobronchitis with necrotic and hemorrhagic materials obstructing the trachea and bronchus. The pandemic 2009 H1N1 influenza virus was detected from the bronchial washing sample; no other microorganism was detected.InterventionHe received peramivir plus oseltamivir and broad-spectrum antibiotics.OutcomesThe bloody secretion continued. He developed cardiac arrest due to airway obstruction on the 6th day of admission. After cardiac arrest, his condition progressed to multi-organ failure, and the patient died on the 10th day of admission.LessonsWe suggest that necrotizing tracheobronchitis be considered in patients with influenza who present with unexplained hypoxemia.

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