title: Acute liver failure, multiorgan failure, cerebral oedema, and activation of proangiogenic and antiangiogenic factors in a case of Marburg haemorrhagic fever.
abstract: A woman developed Marburg haemorrhagic fever in the Netherlands, most likely as a consequence of being exposed to virus-infected bats in the python cave in Maramagambo Forest during a visit to Uganda. The clinical syndrome was dominated by acute liver failure with secondary coagulopathy, followed by a severe systemic inflammatory response, multiorgan failure, and fatal cerebral oedema. A high blood viral load persisted during the course of the disease. The initial systemic inflammatory response coincided with peaks in interferon-γ and tumour necrosis factor-α concentrations in the blood. A terminal rise in interleukin-6, placental growth factor (PlGF), and soluble vascular endothelial growth factor receptor-1 (sVEGF-R1) seemed to suggest an advanced pathophysiological stage of Marburg haemorrhagic fever associated with vascular endothelial dysfunction and fatal cerebral oedema. The excess of circulating sVEGF-R1 and the high sVEGF-R1:PlGF ratio shortly before death resemble pathophysiological changes thought to play a causative part in pre-eclampsia. Aggressive critical-care treatment with renal replacement therapy and use of the molecular absorbent recirculation system appeared able to stabilise--at least temporarily--the patient's condition.
authors.affiliation: Department of Intensive Care, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: van Paassen
authors.forename: Martijn P
authors.initials: MP
authors.lastname: Bauer
authors.forename: M Sesmu
authors.initials: MS
authors.lastname: Arbous
authors.forename: Leo G
authors.initials: LG
authors.lastname: Visser
authors.forename: Jonas
authors.initials: J
authors.lastname: Schmidt-Chanasit
authors.forename: Stefan
authors.initials: S
authors.lastname: Schilling
authors.forename: Stephan
authors.initials: S
authors.lastname: Ölschläger
authors.forename: Toni
authors.initials: T
authors.lastname: Rieger
authors.forename: Petra
authors.initials: P
authors.lastname: Emmerich
authors.forename: Christel
authors.initials: C
authors.lastname: Schmetz
authors.forename: Franchette
authors.initials: F
authors.lastname: van de Berkmortel
authors.forename: Bart
authors.initials: B
authors.lastname: van Hoek
authors.forename: Nathalie D
authors.initials: ND
authors.lastname: van Burgel
authors.forename: Albert D
authors.initials: AD
authors.lastname: Osterhaus
authors.forename: Ann Ctm
authors.initials: AC
authors.lastname: Vossen
authors.forename: Stephan
authors.initials: S
authors.lastname: Günther
authors.forename: Jaap T
authors.initials: JT
authors.lastname: van Dissel
mesh_terms: D000328:Adult; D000818:Animals; D001929:Brain Edema / Q000821:virology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D017114:Liver Failure, Acute / Q000821:virology; D008379:Marburg Virus Disease / Q000097:blood* / Q000150:complications* / Q000628:therapy; D009102:Multiple Organ Failure / Q000821:virology; D000072483:Placenta Growth Factor; D011257:Pregnancy Proteins / Q000097:blood; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
chemical_list: D007375:Interleukin-1; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1