title: Hantavirus and acute appendicitis--the diagnosis behind the diagnosis?
abstract: A 33-year-old man with a history of acute lower abdominal pain was admitted to the emergency room. After laparoscopic appendectomy and pathological confirmed acute appendicitis the patient developed thrombocytopenia and acute renal failure. Serological testing for hantaviruses revealed a positive result for PUUV IgG and IgM. Immunohistochemical work-up detected PUUV antigen in endothelial cells of capillaries and larger vessels. The high percentage of patients with hantavirus infection and severe abdominal pain is remarkable and, up to now, unexplained. To our knowledge this is the first report demonstrating PUUV antigen in the human intestine. Further studies are warranted whether hantaviruses are setting the stage for a secondary bacterial infection or cause an inflammation itself.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany. Joerg.latus@rbk.de
authors.forename: Joerg
authors.initials: J
authors.lastname: Latus
authors.forename: Matthias
authors.initials: M
authors.lastname: Fritzenkötter
authors.forename: Jonas
authors.initials: J
authors.lastname: Schmidt-Chanasit
authors.forename: Klara
authors.initials: K
authors.lastname: Tenner-Racz
authors.forename: Tobias
authors.initials: T
authors.lastname: Leibold
authors.forename: Martin
authors.initials: M
authors.lastname: Kimmel
authors.forename: German
authors.initials: G
authors.lastname: Ott
authors.forename: Evelyn
authors.initials: E
authors.lastname: Ting
authors.forename: Mark Dominik
authors.initials: MD
authors.lastname: Alscher
authors.forename: Niko
authors.initials: N
authors.lastname: Braun
mesh_terms: D000208:Acute Disease; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D000956:Antigens, Viral / Q000032:analysis*; D001064:Appendicitis / Q000175:diagnosis* / Q000473:pathology; D006480:Hemorrhagic Fever with Renal Syndrome / Q000175:diagnosis*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007150:Immunohistochemistry; D007422:Intestines / Q000821:virology; D008297:Male; D029262:Puumala virus / Q000276:immunology*
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M