[Nephropathia epidemica caused by Puumala hantavirus infection: a case report from the outpatient sector]

Abstract

History and admission findings: A 42-year-old man without pre-existing health problems presented to his family practitioner in Baden-Württemberg with fever (up to 39˚ C for two days), headache, abdominal pain, back pain and aching limbs. Ten days before, he had done heavy gardening work. He felt diffuse pain on abdominal palpation. The physical examination of the skin, lymph nodes, the heart, the lungs and the oral mucosa was unremarkable.

Investigations and diagnosis: Erythrocytes, leukocytes and sporadic bacteria were found in the urine. Urine test strip analysis gave a threefold positive result for protein. The blood test revealed in an elevated C-reactive protein, leukocytosis, elevated creatinine and thrombocytopenia. Enlarged kidneys and an enlarged spleen were found on ultra sound examination. IgG and IgM tested for Hantavirus infection were detected by IFA (Immunofluorescence antibody assay) and by ELISA (enzyme-linked immunosorbent assay).

Treatment and course: The blood tests had returned to normal by 15 days after onset of the fever which had persisted for 7 days. Oliguria and/or anuria did not occur. After three weeks of illness, the blood pressure was found to be at hypertensive levels and the patient was treated with antihypertensive drugs.

Conclusion: A history of gardening work (exposure to rodents) and nonspecific symptoms (like headache and fever), in combination with elevated serum creatinine and thrombocytopenia, should raise the suspicion of nephropathia epidemica (hemorrhagic fever with renal syndrome) caused by hantavirus infection. As sequelae of hantavirus infection may persist, patients should subsequently be followed for clinical and laboratory evidence of renal disease. Hospitalization is not generally warranted.