title: Severe Puumala virus infection in a patient with a lymphoproliferative disease treated with icatibant.
abstract: Early identification of patients at risk of a severe course of hantaviral disease and lack of effective medication represent a global challenge in the treatment of this emerging infection. We describe a 67-year-old female patient with a history of chronic lymphoproliferative disease involving the spleen and an extremely severe acute Puumala hantavirus infection. She was treated with the bradykinin receptor antagonist icatibant and recovered. She is the second patient with a spleen abnormality and severe Puumala infection treated with icatibant in our hospital. We suggest that patients with spleen abnormalities may be more susceptible to severe hantavirus disease. The activation of the kinin-kallikrein system and the formation of bradykinin in hantavirus-infected endothelial cells indicate that the role of bradykinin receptor antagonist icatibant in the treatment of hantavirus disease is worth studying.
authors.affiliation: From the Department of Internal Medicine, Tampere University Hospital , Tampere , Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Laine
authors.forename: Ilona
authors.initials: I
authors.lastname: Leppänen
authors.forename: Sirpa
authors.initials: S
authors.lastname: Koskela
authors.forename: Jaakko
authors.initials: J
authors.lastname: Antonen
authors.forename: Satu
authors.initials: S
authors.lastname: Mäkelä
authors.forename: Marjatta
authors.initials: M
authors.lastname: Sinisalo
authors.forename: Antti
authors.initials: A
authors.lastname: Vaheri
authors.forename: Jukka
authors.initials: J
authors.lastname: Mustonen
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D001920:Bradykinin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D065094:Bradykinin B2 Receptor Antagonists / Q000627:therapeutic use; D005260:Female; D006480:Hemorrhagic Fever with Renal Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000150:complications*; D029262:Puumala virus; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D065094:Bradykinin B2 Receptor Antagonists; C065679:icatibant; D001920:Bradykinin
keywords: Bradykinin receptor antagonist; hantavirus; icatibant; lymphoproliferative; spleen