HEMORRHAGIC FEVER WITH RENAL SYNDROME AND COEXISTING PULMONARY SYNDROME: UNNUSUAL PRESENTATION OF HANTAVIRUS INFECTION

Abstract

HEMORRHAGIC FEVER WITH RENAL SYNDROME AND COEXISTING PULMONARY SYNDROME: UNNUSUAL PRESENTATION OF HANTAVIRUS INFECTION V. Karanfilovski, S. Suleyman, Z. Janevski, N. Gjorgjievski, Z. Sterjova Markovska, G. Severova, I. G. Nikolov, L. Trajceska, I. Rambabova-Bushljetik and G. Spasovski University Clinic of Nephrology, Faculty of Medicine, University Sts. Cyril and Methodius Skopje, N, Macedonia PP Introduction. Hantavirus infections traditionally presented in two distinct syndromes, the so-called "Hemorrhagic Fever with Renal Syndrome" (HFRS) with the kidneys as main target organs, in contrast to "Hantavirus Pulmonary Syndrome" (HPS) with the lungs as main target organs. However, the numbers of reported HFRS cases with lung involvement and HPS cases with renal and/or hemorrhagic involvement are continuously growing, emphasizing the need to reconsider the paradigm of two different syndromes. Methods. We described two cases of young males with Hantavirus infection who presented with fever, abdominal pain, thrombocytopenia, hemorrhage and acute kidney injury requiring hemodialysis treatment. Both cases followed an atypical clinical course with cardio-pulmonary affection and development of hypotension and acute respiratory distress syndrome (ARDS) with need of mechanical ventilation in one of the patients. Results. Ultimately, both patients experienced gradual improvement of renal and cardio-pulmonary function, and developed no chronic complications. Conclusion. Both syndromes caused by Hantavirus are immune-mediated and overactive immune response and endothelial dysfunction in various organs could lead to wide spectrum of clinical presentations and overlapping syndromes. Hantavirus should be considered as a possible etiological factor in patient presenting with pulmonary-renal syndrome.