Oseltamivir and baloxavir: Dual treatment for rapidly developing ARDS on a patient with renal disease

Highlights

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  Baloxavir is an antiviral influenza medication with a different mechanism of action and its use in combination with oseltamivir has not been reported on patients with severe renal impairment.

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  Immunocompromise patients have a tendency to develop more severe forms of influenza infection. They may benefit from dual therapy.

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  Combination therapy may fasten overall recovery time and decrease the time on extracorporeal oxygenation support.

Abstract

Influenza is an annual epidemic disease that in severe cases can lead to the development of ARDS. Current practice recommends the routine use of neuraminidase inhibitors with emerging evidence for the use of endonuclease inhibitors. We present the case of a 22-year-old female with diabetes and IgG4 tubulo-interstitial nephritis that developed rapidly progressive ARDS from influenza infection requiring ventilatory support and extra corporeal oxygenation in which oseltamivir and baloxavir were used in combination. Patient oxygen requirements and imaging improved significantly after treatment initiation, leading to an overall short period of therapy. We present the first case of a patient treated with this combination in the context of chronic kidney disease.