Hemorrhagic fever with renal syndrome presenting with intrauterine fetal death. A case report.

BACKGROUND: Hantavirus infection in pregnancy is rare. Only 2 cases of hantavirus pulmonary syndrome have been reported in the English-language literature. We report a case of hemorrhagic fever with renal syndrome (HFRS) complicating pregnancy to alert clinicians to this rare possibility. CASE: A 29-year-old woman had experienced persistent, high fever for 6 days, no fetal movement for 2 days and frequent vomiting for 1 day before being referred to our department with the additional symptoms of headache, lumbodynia and orbital pain. On examination, she had a normal body temperature, flushing of the face, conjunctive congestion, pharyngeal congestion, bulbar conjunctive edema, severe jaundice, petechiae and ecchymosis at sites of venipuncture, deranged liver and renal function tests, heavy proteinuria and hematuria, and coagulation disturbance. The diagnosis of HFRS complicating pregnancy was made on account of the clinical picture and antihantavirus IgM titer of 1:20. The patient's condition quickly deteriorated, with frank hematuria, oliguria and finally anuria, together with shock. Hemodialysis was immediately commenced, and a stillborn, male infant, of 3,200 g, was delivered vaginally following combined induction 12 hours after hemodialysis. The fetus showed no obvious abnormalities, but the parents declined an autopsy. After hemodialysis and delivery, the patient recovered and was discharged 3 weeks later. The repeat titer for antihantavirus IgM was 1:80 10 days after presentation.
CONCLUSION: HFRS is a rare complication of pregnancy. The symptoms are nonspecific. Early diagnosis and appropriate management are necessary to improve the maternal and fetal outcome. Clinicians should include this condition in the differential diagnoses when a combination of hematologic, hepatic, renal and gastrointestinal problems presents in pregnancy.