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To the Editor: A 56-year-old man came to the emergency department (ED) of Malcolm Grow Medical Center at Andrews Air Force Base in suburban Maryland, USA, just outside Washington, DC. He had a history of several days of cough, fever, and malaise; was a nonsmoker; was overweight (body mass index 28 kg/m2); and did not have chronic pulmonary disease. Radiographs showed bilateral pulmonary infiltrates, and he was hypoxemic. Two weeks previously, the patient had begun receiving therapy for recurrent multiple myeloma (lenalidomide and high-dose dexamethasone). He was intubated at the time of initial visit to the ED for influenza symptoms, and broad-spectrum antimicrobial drugs were administered (vancomycin 1,000 mg every 12 h, piperacillin-tazobactam 4.5 gm every 6 h, and levofloxacin 750 mg 1×/d). Initial nasopharyngeal wash was negative for influenza A and B antigen by enzyme immunoassay; serum creatine kinase was 271 U/L (reference range 38–174 U/L).

Rhabdomyolysis and Pandemic (H1N1) 2009 Pneumonia in Adult