Plasma Exchange—Associated Immunoglobulin M—Negative Hantavirus Disease after a Camping Holiday in Southern France

A 37-year-old Belgian patient presented with acute nephropathia epidemica (NE) shortly after a camping holiday in southern France. Unusual symptoms were initial noncardiogenic lung involvement, followed by severe acute renal failure, acute acalculous cholecystitis, presence of immunoblasts in the bo...

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Bibliographic Details
Published in:Clinical infectious diseases 2004-05, Vol.38 (10), p.1350-1356
Main Authors: Keyaerts, Els, Ghijsels, Erik, Lemey, Philippe, Maes, Piet, Zachée, Pierre, Daelemans, Ronald, Vervoort, Tony, Mertens, Gerhard, Van Ranst, Marc, Clement, Jan
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Camping
Enzyme-Linked Immunosorbent Assay
Epidemiology
France
Gastroenterology. Liver. Pancreas. Abdomen
Hantavirus
Hantavirus Infections - immunology
Hantavirus pulmonary syndrome
Hemolytic uremic syndrome
Hemorrhagic fever with renal syndrome
Hemorrhagic Fever with Renal Syndrome - immunology
Hemorrhagic Fever with Renal Syndrome - virology
Humans
Iatrogenic Disease
Immunoglobulin M - immunology
Infections
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Lungs
Major Articles
Male
Medical sciences
Nephrology. Urinary tract diseases
Nephropathies. Renovascular diseases. Renal failure
Other diseases. Semiology
Puumala hantavirus
Renal failure
Rodents
Viruses
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Summary:A 37-year-old Belgian patient presented with acute nephropathia epidemica (NE) shortly after a camping holiday in southern France. Unusual symptoms were initial noncardiogenic lung involvement, followed by severe acute renal failure, acute acalculous cholecystitis, presence of immunoblasts in the bone marrow, and hemolytic anemia, presenting as hemolytic uremic syndrome. Positive immunoglobulin (Ig) A and rising IgG titers against Puumala hantavirus (PUUV) were detected, but IgM remained negative on days 8 and 20. The results of reverse-transcriptase–polymerase chain reaction performed on day 8 were positive for PUUV. This is the first report of an iatrogenically IgM-negative hantavirus case due to the selective removal of heavy-weight molecules during plasma exchange via the centrifugation technique. This is also the first report of proven NE from the Mediterranean part of France.
ISSN:1058-4838
1537-6591
DOI:10.1086/383311