E.V. FROLOVA^{1, 2}, V.G. SHAKIROVA^{1, 2}, I.M. KHAERTYNOVA¹

 ¹Kazan State Medical Academy — Branch Campus of the FSBEI FPE RMACPE MOH Russia, Kazan

²Republic Clinical Infectious Hospital named after Prof. A.F. Agafonov, Kazan

Contact details:

Frolova E.V. — postgraduate student, Department of Infectious Diseases, infectious disease physician

Address: 36 Butlerov St., 420012 Kazan, Russian Federation, tel.: +7-909-300-44-07, e-mail: kulakova_ksmu@mail.ru

Puumala virus-induced hemorrhagic fever with renal syndrome (HFRS) is traditionally regarded as a variant of orthohantavirus infection with a relatively mild clinical course.

This case report shows the risk of extremely severe Puumala-associated HFRS course in a patient with an anatomically solitary kidney and discusses pathogenetic factors contributing to the fatal outcome. We describe a case of a young patient with previously undiagnosed right kidney aplasia who, against the background of Puumala-associated HFRS, rapidly developed a pronounced systemic inflammatory and metabolic response, severe acute injury of the solitary kidney, hemorrhagic manifestations, respiratory failure, and multiple organ dysfunction. This required intensive care and renal replacement therapy. Clinical, laboratory, and imaging findings are presented, along with post-mortem examination results. The observation emphasizes the key role of host-related factors, including congenital reduction of nephron reserve and dysregulated immuno-inflammatory response, in the development of severe Puumala-associated HFRS and an adverse outcome.

Key words: hemorrhagic fever, Puumala orthohantavirus, acute kidney injury, renal aplasia.

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