Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5795
Peer-review started: August 21, 2020
First decision: September 13, 2020
Revised: September 13, 2020
Accepted: September 23, 2020
Article in press: September 23, 2020
Published online: November 26, 2020
Processing time: 96 Days and 7.6 Hours
Hemorrhagic fever with renal syndrome is caused by hantaviruses presenting with high fever, hemorrhage, and acute kidney injury. Microvascular injury and hemorrhage in mucus were often observed in patients with hantavirus infection. Infection with bacterial and virus related aortic aneurysm or dissection occurs sporadically. Here, we report a previously unreported case of hemorrhagic fever with concurrent aortic dissection.
A 56-year-old man complained of high fever and generalized body ache, with decreased platelet counts of 10 × 109/L and acute kidney injury. The enzyme-linked immunosorbent assays test for immunoglobulin M and immunoglobulin G hantavirus-specific antibodies were both positive. During the convalescent period, he complained sudden onset acute chest pain radiating to the back, and the computed tomography angiography revealed an aortic dissection of the descending aorta extending to iliac artery. He was diagnosed with hemorrhagic fever with renal syndrome and Stanford B aortic dissection. The patient recovered completely after surgery with other support treatments.
Hemorrhagic fever with renal syndrome complicated with aortic dissection is rare and a difficult clinical condition. Hantavirus infection not only causes microvascular damage presenting with hemorrhage but may be risk factor for acute macrovascular detriment. A causal relationship has yet to be confirmed.
Core Tip: Microvascular injury presenting with hemorrhage in mucus is a typical symptom in hemorrhagic fever with renal syndrome (HFRS) patients. Infection related aortic dissection occurs sporadically, and there has been no report of concurrent HFRS and aortic dissection. HFRS complicated with aortic dissection is rare and a difficult clinical condition that deserves further study and discussion.