Here we present a case of a 37-year-old soldier of Indian Army, posted in high altitude area of Ladakh region (>4200 m), who after rejoining after a month leave, presented with dry cough, low-grade fever and dyspnoea on exertion while undergoing acclimatisation, and on examination, was detected to have hypoxaemia, fever and bilateral fine crepitations on chest auscultation. He was started on treatment for high altitude pulmonary oedema at a medical aid post, and later referred to General Hospital at Leh. The course of the illness was complicated by worsening hypoxaemia, continuous high-grade fever, leucopenia and hypotension. Focused medical history revealed that he had travelled to the state of Gujarat during his leave, where high incidence of H1N1 influenza was being reported during the ongoing pandemic. Oseltamivir was empirically started, in addition to parenteral antibiotics and he was started on inotropic support. In view of severe hypoxaemia, not responding to non-invasive ventilation, he was intubated and placed on mechanical ventilation. The patient turned out to be H1N1 positive and succumbed to his illness 3 days later.
- travel medicine
- respiratory medicine
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Contributors VJ has contributed the original idea for this case report and drafted the initial manuscript. AJ has contributed to the editing and revision of the manuscript. Both the contributors were involved in the management of the case.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Next of kin consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.