A 14-year-old boy of previously good health was hospitalized with a history of fever, headache, nausea and lumbal pain. Within 4 days he developed acute renal failure and thrombocytopenia. Urine analysis disclosed proteinuria of 2 g/d and microscopic hematuria. Renal ultrasound showed enormously enlarged kidneys of 820 ml volume. Renal biopsy was performed and revealed interstitial infiltrates with immune cells and interstitial haemorrhage in the renal medulla, consistent with haemorrhagic interstitial nephritis.
Based on the clinical manifestation, laboratory parameters and histological findings hanta virus infection was strongly suspected and confirmed by Western blot analysis.
On further questioning the patient reported that he frequently discharges rodents from mousetraps in the cellar. This makes inhalation of rodent excrement the most likely mode of infection in this case, with the bank vole being the main vector of hanta virus in this region of Germany.
The patient’s renal function recovered gradually and renal volume decreased to normal size. He was discharged after 8 days of hospitalization without any renal replacement therapy and remained well at 1 year follow-up.
Hanta virus nephritis should be suspected in every case with febrile back pain, thrombocytopenia and renal failure. A detailed history is helpful to disclose the mode of viral transmission.
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