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Acute Appendicitis Associated with Hantaan Virus Infection

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  • 1 Department of Pathology, Chosun University College of Medicine, Dong-gu, Gwangju, South Korea;
  • | 2 Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea;
  • | 3 Premedical Science, College of Medicine, Chosun University, Gwangju, South Korea

ABSTRACT.

Hantaviruses are Bunyaviridae viruses that cause hemorrhagic fever with renal syndrome. Appendicitis caused by Hantaan virus has not been reported previously. An 81-year-old man who underwent laparoscopic appendectomy for suspected appendicitis based on abdominal pain, fever, hypotension, and computed tomography findings. Based on a suspicion of hemorrhagic fever with renal syndrome, the patient’s plasma was simultaneously analyzed using an indirect immunofluorescent antibody assay and nested reverse transcription–polymerase chain reaction (RT-PCR). The appendix tissue was also analyzed using nested RT-PCR and immunohistochemical (IHC) staining to identify the presence of Hantaan virus. Nested RT-PCR detected the presence of Hantaan virus, and indirect immunofluorescent antibody assay results revealed the presence of elevated antibody levels. Furthermore, IHC staining of the appendix tissue confirmed Hantaan virus antigens in the peripheral nerve bundle. Based on these findings, we confirmed the nerve tropism of the Hantaan virus. Hantaan virus in plasma and appendix tissue samples was confirmed using PCR and phylogenetic tree analysis. Moreover, we detected hypertrophy of the submucosa and periappendiceal adipose tissue nerve bundle along with Hantaan virus antigens in peripheral nerve bundles using IHC staining. Hence, we report that Hantaan virus infection may be accompanied by appendicitis.

Author Notes

 Address correspondence to Dong-Min Kim, Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju 501-717, South Korea. E-mail: drongkim@chosun.ac.kr

These authors contributed equally to this work.

These authors contributed equally to this work.

Disclosure: This study was approved by the Ethics in Human Research Committee of Chosun University Hospital (IRB No. 2013-10-001-018). Written informed consent from the patients’ representative was obtained prior to participate in the study.

Authors’ addresses: Sung-Chul Lim, Department of Pathology, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju, South Korea, E-mail: sclim@chosun.ac.kr. Young Min Lee, Na Ra Yun, and Dong-Min Kim, Department of Internal Medicine, Chosun University College of Medicine, 588 Seosuk-dong, Dong-gu, Gwangju, South Korea, E-mails: topmal@gmail.com, shine@chosun.ac.kr, and drongkim@chosun.ac.kr. Choon-Mee Kim, Premedical Science, College of Medicine, Chosun University, 588 Seosuk-dong, Dong-gu, Gwangju, South Korea, E-mail: choonmee@chosun.ac.kr.

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