Hemorrhagic Fever with Renal Syndrome Complicated with Pregnancy: A Case Report
A 31-year-old, otherwise healthy, woman, (gravida 0 and para 0), at 15 weeks of gestation was admitted to our hospital on October 29, 2004 due to fever, chills, eyeball pain and back pain of 4 days' duration. The patient had undergone intrauterine insemination on June 24, 2004 before achieving pregnancy. She began to complain of facial edema and blurred vision just after admission. She denied having a cough, diarrhea or dysuria. She and her husband were beef cattle-breeders in the rural Yangju area of Gyeonggi Province, Korea. On examination, her blood pressure was 110/80 mm Hg and her temperature was 38.3℃. She displayed flushing of the face, conjunctival hemorrhage and bulbar conjunctival edema. Her chest auscultation was normal. Mild tenderness was bilaterally found on her costovertebral angle, but no skin rash was evident. The laboratory tests revealed the following: leukocyte count: 21,300/µL (normal range: 4,000-10,000/µL), platelets: 83,000/µL (normal range: 150,000-400,000/µL), creatinine: 0.9 mg/dL (normal range: 0.7-1.4 mg/dL), aspartate transaminase: 67 U/L (normal range: <40 U/L), sodium: 135 mmol/L (normal range: 135-145 mmol/L), and potassium: 3.8 mmol/L (normal range: 3.5-5.5 mmol/L). Urinalysis revealed proteinuria and hematuria. Cultures of her blood and urine were sterile. Fetal ultrasound showed fetal growth that was consistent with the gestation dates.\nHer condition deteriorated over the following days. Her blood pressure dropped to as low as 60/40 mmHg despite massive administration of physiologic saline on day 2, and her platelet count decreased to 15,000/µL on day 5. Her oliguria and elevated serum creatinine levels of up to 4.2 mg/dL necessitated the administration of diuretics intermittently from day 3 to day 7. However, from day 8 her renal functions progressively improved. The patient recovered completely and was discharged on day 14. The antibody titer for Hantaan virus, which was determined using a high-density particle agglutination test (Hantadia, Greencross, Korea) was 1:640 on day 5. A repeat titer showed an increase to 1:2,560 at the time of discharge, but it was 1:1,280 two weeks after discharge. Serologic tests for Leptospira, Orientia tsutsugamushi and HIV were negative.\nThe pregnancy continued uneventfully, and the patient was lost to follow-up. Six months later, she vaginally delivered a 2,900-g healthy female infant without complications at another hospital. However, no additional tests for Hantaan virus were performed on her or her baby at the time of delivery.