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Case Report: Spinal Subarachnoid Hemorrhage: A Rare Complication of Hemorrhagic Fever with Renal Syndrome

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  • 1 Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
  • 2 Department of Post Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;
  • 3 Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;
  • 4 Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

ABSTRACT

Hemorrhagic fever with renal syndrome (HFRS), caused by hantavirus, is occasionally seen in tropical areas. The virus is carried by specific rodent host species. Hemorrhagic fever with renal syndrome is characterized by renal failure and hemorrhagic manifestations, and its complications may be severe, including massive bleeding, multi-organ dysfunction, and possibly death. In this patient case, a 46-year-old woman diagnosed with HFRS initially presented with fever, impaired renal function, and thrombocytopenia. Four days after symptom onset, the patient complained of abrupt right lower abdominal pain and numbness. Magnetic resonance imaging revealed a spinal subarachnoid hemorrhage (SAH) beyond the T7 to S2 vertebrae. No cases of spinal SAH in HFRS have been reported until now. This case demonstrates that when a patient’s symptoms are atypical, bleeding-related complications must be considered.

Author Notes

Address correspondence to Tun-Chieh Chen, Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Taiwan No. 68, Jhonghua 3rd Rd., Cianjin District, Kaohsiung City 80145, Taiwan. E-mail: kmtthidchen@gmail.com

Authors’ addresses: Shih-Hao Lo, Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan, E-mail: pipy0529@gmail.com. Pei-Ting Chen, Department of Post Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, E-mail: b96207045@gmail.com. Wan-Jin Yu and Ke-Syuan Hsieh, Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, E-mails: winniestatham@gmail.com and gg31540@gmail.com. Tun-Chieh Chen, Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Taiwan, E-mail: kmtthidchen@gmail.com.

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