icatibant and Hemorrhagic-Fever-with-Renal-Syndrome

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.

Topics: Aged; Antiviral Agents; Bradykinin; Bradykinin B2 Receptor Antagonists; Female; Hemorrhagic Fever with Renal Syndrome; Humans; Lymphoproliferative Disorders; Puumala virus; Treatment Outcome

We recently described a patient with very severe Puumala hantavirus infection manifested by capillary leakage syndrome and shock. He was successfully treated with the bradykinin receptor antagonist, icatibant (Antonen et al., 2013). Here we report analysis of the pathophysiology which indicated pronounced complement activation, prolonged leukocytosis, extensive fibrinolysis, circulating histones, and defects in liver function. The patient had an uncommon HLA-phenotype, which may have contributed to the severe course of the disease.

Topics: Adult; Bradykinin; Bradykinin Receptor Antagonists; Hemorrhagic Fever with Renal Syndrome; Humans; Male; Puumala virus; Receptors, Bradykinin