Severe Puumala virus infection in a patient with a lymphoproliferative disease treated with icatibant

• Published in: Infectious diseases (London, England) Vol. 47; no. 2; pp. 107 - 111
• Main Authors: Laine, Outi, Leppänen, Ilona, Koskela, Sirpa, Antonen, Jaakko, Mäkelä, Satu, Sinisalo, Marjatta, Vaheri, Antti, Mustonen, Jukka
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare 01-02-2015
• Subjects: Aged; Antiviral Agents - therapeutic use; Bradykinin - analogs & derivatives; Bradykinin - therapeutic use; Bradykinin B2 Receptor Antagonists - therapeutic use; Female; Hemorrhagic Fever with Renal Syndrome - diagnosis; Hemorrhagic Fever with Renal Syndrome - drug therapy; Hemorrhagic Fever with Renal Syndrome - virology; Humans; Lymphoproliferative Disorders - complications; Puumala virus; Treatment Outcome; lymphoproliferative; icatibant; hantavirus; spleen; Bradykinin receptor antagonist
• ISSN: 2374-4235; 2374-4243
• DOI: 10.3109/00365548.2014.969304

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.