Beyond the Final Breath: Postmortem Diagnosis of Hantavirus Pulmonary Syndrome

Document Type

Abstract

Publication Date

5-1-2025

Abstract

Introduction: Hantavirus, a zoonotic virus transmitted to humans by inhalation of aerosolized excrement from infected rodents. Hantavirus Pulmonary Syndrome (HPS) is one of the major manifestations in humans. We present a challenging case of HPS that was diagnosed postmortem. Case presentation: A 36-year-old nonsmoker female presented with shortness of breath, mucoid cough, myalgia, and fever of one-day duration. She denied chest pain, sick contacts, recent travel. She was a cashier at a family-owned meat shop. Vitals T 102.4F, tachypneic, saturating 70% on RA. Exam was remarkable for coarse breath sounds with bilateral crackles. Computed Tomography of Chest showed diffuse interstitial edema and multifocal infiltrates(Figure A/B). Pertinent blood work showed leukocytosis with left shift. Normal platelets. ABG: pH 7.22, pCO2 35 pO2 95 on presentation, on non-invasive ventilation (NIV). She was started on broad spectrum antibiotics. Approximately four hours later, she developed significant respiratory distress requiring intubation. Shortly thereafter, she developed severe shock requiring vasopressors. Despite maximal support with mechanical ventilation, she remained hypoxic to 60-65% which prompted emergent Extracorporeal Membrane Oxygenation (ECMO). Unfortunately, in the interim, she sustained a cardiac arrest and deceased. Upon enquiring with family, she had exposure to rodents. This was key to her diagnosis, which unfortunately came into light rather delayed. Based on rodent exposure, the acuity of her illness with rapid deterioration, Hantavirus Pulmonary Syndrome was suspected. Autopsy revealed Acute Pneumonitis with Diffuse Alveolar Damage (Figure C/D). Immunohistochemical (IHC) stains confirmed Hantavirus antigens in the lungs and kidneys (Figure E/F). Discussion: Hantavirus Pulmonary syndrome can range from mild to severe forms, the latter has high case fatality rates of up to 50%1. Often has prodromal phase mimicking viral infections which poses a diagnostic challenge. Pathogenesis involves endothelial dysfunction resulting in capillary leak, and dysregulated immune response2. In severe forms with cardiopulmonary involvement, the onset of hypotension and noncardiogenic pulmonary edema is rapid and fatal. Although there are no definitive criteria for diagnosis, in endemic areas, a triad of thrombocytopenia, presence of immunoblasts, and a left-shifted granulocytes are used in suspecting HPS3. Testing includes hantavirus specific IgM or IgG; RNA in clinical specimens, or IHC in lung biopsy or autopsy tissues. Management is mainly supportive therapy with lung protective ventilation, early consideration of ECMO. There is no antiviral therapy yet. Conclusion: Hantavirus Pulmonary Syndrome has high fatality rates. This case report highlights the importance of thorough social history, and the challenges posed in diagnosing such cases.

Publication Title

American Journal of Respiratory and Critical Care Medicine

Volume

211

Issue

Abstracts

First Page

A7838

Last Page

A7838

Comments

American Thoracic Society International Conference, ATS 2025 held 2025-05-16 to 2025-05-21 in San Francisco, CA

Link to Full Text

Open Access

Share

COinS