(551) A Complex Case of Hantavirus Pulmonary Syndrome and Hemorrhagic Fever With Renal Syndrome

Introduction: Hantaviruses, hosted by rodents and transmitted to humans via aerosolized virus in rodent excretions, can cause Hantavirus Pulmonary Syndrome (HPS) and Hemorrhagic Fever with Renal Syndrome (HFRS). HPS, often caused by the Sin Nombre virus, is prevalent in the US, especially in rural areas. HFRS, caused by various hantaviruses, is common in Asia and Europe.

This report discusses a patient with features of both HPS and HFRS. A 52-year-old crane operator from rural Louisiana presented with fever, fatigue, myalgia, and rapidly progressing shortness of breath. He was normothermic, mildly hypotensive, tachycardic, and hypoxic, with dry mucous membranes and mild epigastric tenderness.

Description: A 52-year-old crane operator from rural Louisiana presented with fever, fatigue, myalgia, and rapidly progressing shortness of breath. He was normothermic, mildly hypotensive, tachycardic, and hypoxic, with dry mucous membranes and mild epigastric tenderness.

Laboratory investigations revealed leukocytosis, thrombocytopenia, elevated liver enzymes, and abnormal renal function. A chest X-ray showed bilateral interstitial infiltrates. His condition deteriorated over 48 hours, requiring intubation and mechanical ventilation. He developed acute respiratory failure, renal failure and septic shock complicated by disseminated intravascular coagulation (DIC) secondary to hantavirus infection, confirmed by serological testing. Despite aggressive care, he developed multi-organ failure and unfortunately succumbed to his illness.

Discussion: This case underscores the importance of considering hantavirus infection in patients presenting with severe respiratory illness, thrombocytopenia, and evidence of coagulopathy, particularly in those with potential rodent exposure. The patient's occupation and rural residence were key epidemiological clues that led to the consideration of hantavirus infection. This case also highlights the challenges in diagnosing hantavirus infection, given its non-specific initial presentation and rapid progression to severe disease. Increased awareness and early recognition of the disease can potentially improve patient outcomes.