Flu B or not Flu B: An atypical case of minimal change disease triggered by Influenza B presenting with multi-organ dysfunction

Minimal change disease (MCD) accounts for 10-15% of idiopathic nephrotic syndrome in adults. Patients typically present with nephrotic range proteinuria, hypertension, microscopic hematuria and can even progress to acute renal failure. MCD can be primary (idiopathic) or secondary from etiologies such as cancer, medications, autoimmune conditions and infections. The link between infectious etiologies for MCD is important to recognize, since MCD tends to show a good response to treatment of the underlying cause. Influenza A has been reported as a secondary cause of MCD and rarely, influenza A, not B, can also present with liver failure. We present an atypical case of a 60-year-old female with no past medical history who presented with liver failure along with acute kidney injury and nephrotic range proteinuria. She was diagnosed with liver failure and secondary MCD from influenza B, the first reported case, and made a full recovery with treatment of Influenza B.