Severe thrombocytopenia and response to corticosteroids in a case of nephropathia epidemica

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
R DunstU Kuhlmann

Abstract

Nine days after working in the woods, a previously healthy 32-year-old man fell seriously ill. His symptoms included high fever, chills, diffuse myalgia, severe headache, and back pain. On the fifth day of onset of symptoms, blood tests showed creatinine levels of 5.4 mg/dL accompanied by marked proteinuria. After admission to the hospital, a diagnosis of nephropathia epidemica (NE) caused by Puumala virus was made using solid-phase enzyme-linked immunosorbent assay (ELISA). The patient gradually recovered renal function without requiring dialysis. However, he surprisingly experienced a sharp decline in platelet count to a minimum of 2,000/microL with concomitant occurrence of petechiae and conjunctival hemorrhage. Prednisolone was initiated, resulting in a swift rise in platelets. Six days later, when the medication was withdrawn, a sharp decrease in platelets recurred. The steroids were then readministered for the next 3 months, thus reestablishing a stable platelet count. The immediate rise of platelets after administration of prednisolone supports the pathophysiological view of hantavirus infection as an immunologically mediated disease. Corticosteroids in the treatment of hantavirus-associated thrombocytopenia might need f...Continue Reading

Citations

Mar 13, 2010·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Niko BraunChristian S Haas
Dec 2, 2008·PLoS Pathogens·Judith D Easterbrook, Sabra L Klein
Nov 3, 2010·Mayo Clinic Proceedings·Barbara DeneckeChristian S Haas
Aug 13, 2013·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Maja Martinuč BergočJernej Pajek
Aug 30, 2012·Journal of Medical Virology·M GoeijenbierE C M van Gorp
Jan 22, 2003·Intensive Care Medicine·Josef FinstererChristian Prainer
May 13, 2009·Southern Medical Journal·Donald C Vinh, John M Embil

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