Qiu Feng-Qi, Li Cong-Cong, Zhou Jian-Ya
Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China.
Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China.
World J Clin Cases. 2020 Nov 26;8(22):5795-5801. doi: 10.12998/wjcc.v8.i22.5795.
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 × 10/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.
肾综合征出血热由汉坦病毒引起，表现为高热、出血和急性肾损伤。汉坦病毒感染患者常观察到微血管损伤和黏膜出血。细菌和病毒相关的主动脉瘤或夹层感染偶有发生。在此，我们报告一例此前未报道的并发主动脉夹层的出血热病例。
一名56岁男性主诉高热和全身疼痛，血小板计数降至10×10⁹/L，伴有急性肾损伤。汉坦病毒特异性抗体免疫球蛋白M和免疫球蛋白G的酶联免疫吸附测定试验均呈阳性。在恢复期，他突然出现放射至背部的急性胸痛，计算机断层血管造影显示降主动脉夹层延伸至髂动脉。他被诊断为肾综合征出血热和斯坦福B型主动脉夹层。患者在接受手术及其他支持治疗后完全康复。
肾综合征出血热并发主动脉夹层罕见且临床情况棘手。汉坦病毒感染不仅导致微血管损伤并伴有出血，还可能是急性大血管损害的危险因素。因果关系尚待证实。
