title: Plasma exchange-associated immunoglobulin m-negative hantavirus disease after a camping holiday in southern france.
abstract: A 37-year-old Belgian patient presented with acute nephropathia epidemica (NE) shortly after a camping holiday in southern France. Unusual symptoms were initial noncardiogenic lung involvement, followed by severe acute renal failure, acute acalculous cholecystitis, presence of immunoblasts in the bone marrow, and hemolytic anemia, presenting as hemolytic uremic syndrome. Positive immunoglobulin (Ig) A and rising IgG titers against Puumala hantavirus (PUUV) were detected, but IgM remained negative on days 8 and 20. The results of reverse-transcriptase-polymerase chain reaction performed on day 8 were positive for PUUV. This is the first report of an iatrogenically IgM-negative hantavirus case due to the selective removal of heavy-weight molecules during plasma exchange via the centrifugation technique. This is also the first report of proven NE from the Mediterranean part of France.
authors.affiliation: Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, University of Leuven, BE-3000 Leuven, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Keyaerts
authors.forename: Erik
authors.initials: E
authors.lastname: Ghijsels
authors.forename: Philippe
authors.initials: P
authors.lastname: Lemey
authors.forename: Piet
authors.initials: P
authors.lastname: Maes
authors.forename: Pierre
authors.initials: P
authors.lastname: Zachée
authors.forename: Ronald
authors.initials: R
authors.lastname: Daelemans
authors.forename: Tony
authors.initials: T
authors.lastname: Vervoort
authors.forename: Gerhard
authors.initials: G
authors.lastname: Mertens
authors.forename: Marc
authors.initials: M
authors.lastname: Van Ranst
authors.forename: Jan
authors.initials: J
authors.lastname: Clement
mesh_terms: D000328:Adult; D004797:Enzyme-Linked Immunosorbent Assay; D005602:France; D006476:Orthohantavirus; D018778:Hantavirus Infections / Q000276:immunology*; D006480:Hemorrhagic Fever with Renal Syndrome / Q000276:immunology* / Q000821:virology; D006801:Humans; D007049:Iatrogenic Disease; D007075:Immunoglobulin M / Q000276:immunology*; D008297:Male
chemical_list: D007075:Immunoglobulin M