H1N1 influenza virus as a cause of peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a rare complication characterized by heart failure that arises between the last month of pregnancy and the first 5 weeks after delivery. The etiology of this disorder has not been clarified due to its low incidence, although some risks factors have been described and recent evidence points towards viral infection as one of the triggers for this disorder. We describe the case of a 32-year-old Caucasian woman who suffered from sudden left heart dysfunction one week after delivery of twins and she simultaneously presented HIN1 influenza infection. The differential diagnosis between H1N1 myocarditis and PPCM arose, but H1N1 myocarditis was discarded by aid of magnetic resonance imaging. Thus, PPCM was confirmed. The patient was treated at first with conventional congestive heart failure therapy, but she did not improve consistently until she was treated with oseltamivir. This fact suggests that H1NI influenza virus might have an indirect role in the development of PPCM probably through an autoimmune mechanism. This case introduces oseltamivir as an effective treatment for this disorder along with conventional heart failure therapy when an association with HIN1 Influenza virus is suspected. Also, second or third trimester HIN1 Influenza vaccination should be strongly recommended in all pregnant women.