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Hemorrhagic Fever with Renal Syndrome as a Cause of Acute Diarrhea

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  • 1 Department of Pulmonary and Critical Care Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea;
  • | 2 Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea;
  • | 3 Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea;
  • | 4 Department of Bio-Medical Sciences, College of Medicine, Chosun University, Gwangju, Republic of Korea
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Hemorrhagic fever with renal syndrome (HFRS) is a febrile disorder caused in Korea by the Hantaan and Seoul viruses. Its characteristic clinical manifestations include fever, hemorrhage, and renal failure, but a primary presentation with acute infectious diarrhea is rare. Owing to decreased urine output and renal function, a 54-year-old patient was transferred to our hospital from a local clinic, where he had been receiving treatment for diarrhea occurring more than 10 times a day. The patient was treated in the Gastroenterology Department at our hospital for acute renal failure secondary to inflammatory diarrhea based on the findings of stool leukocytes. An immunofluorescent antibody assay showed a 4-fold increase in the acute-phase antibody titer to Hantavirus during recovery. A nested reverse transcription polymerase chain reaction (RT-nPCR) assay of plasma yielded negative results, but Hantaan virus positivity was confirmed on an RT-nPCR assay of the buffy coat. Another 60-year-old patient with watery diarrhea was treated conservatively for suspected infectious diarrhea. However, an immunofluorescent antibody assay showed a 4-fold increase in the acute-phase HFRS antibody titer. RT-nPCR using plasma yielded negative results, but Seoul virus was detected on an RT-nPCR buffy coat assay, confirming the diagnosis of HFRS. Hemorrhagic fever with renal syndrome can present with gastrointestinal symptoms such as acute diarrhea alone. This report highlights the importance of considering HFRS in the differential diagnosis of patients with acute diarrhea and the need for additional research on the usefulness of the buffy coat in the PCR diagnosis of HFRS.

Author Notes

Address correspondence to Dong-Min Kim, Department of Internal Medicine, School of Medicine, Chosun University, 588 Seosuk-dong, Dong-gu, Gwangju 61453, Republic of Korea. E-mail: drongkim@chosun.ac.kr

Financial support: This study was supported by research fund from Chosun University, 2017.

Disclosure: This study was approved by the IRB of Chosun University. A written consent to participate in this study was obtained from the patient. Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient.

Authors’ addresses: Hyun Kuk Kim, Department of Pulmonary and Critical Care Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea, E-mail: khkmd1205@hanmail.net.Jong-Hoon Chung, Dong-Min Kim, and Na-Ra Yun, Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, South Korea, E-mails: jhchung@chosun.ac.kr, drongkim@chosun.ac.kr, and shine@chosun.ac.kr. Choon-Mee Kim, Premedical Science, College of Medicine, Chosun University, Gwangju, South Korea, E-mail: choonmee@chosun.ac.kr. Sehrish Jalal, Department of Bio-Medical Sciences, College of Medicine, Chosun University, Gwangju, Republic of Korea, E-mail: jalalsehrish@gmail.com.

These authors contributed equally to this work.

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