SEVERE THROMBOCYTOPENIA AND RESPONSE TO CORTICOSTEROIDS IN A CASE OF NEPHROPATHIA-EPIDEMICA

Nine days after working in the woods, a previously healthy 32-year-old man fell seriously ill. His symptoms included high fever, chills, dif fuse myalgia, severe headache, and back pain, On the fifth day of onse t of symptoms, blood tests showed creatinine levels of 5.4 mg/dL accom panied by marked proteinuria. After admission to the hospital, a diagn osis of nephropathia epidemica (NE) caused by Puumala virus was made u sing solid phase enzyme-linked immunosorbent assay (ELISA), The patien t gradually recovered renal function without requiring dialysis, Howev er, he surprisingly experienced a sharp decline in platelet count to a minimum of 2,000/mu L with concomitant occurrence of petechiae and co njunctival hemorrhage, Prednisolone was intitiated, resulting in a swi ft rise in platelets, Six days later, when the medication was withdraw n, a sharp decrease In platelets recurred. The steroids were then read ministered for the next 3 months, thus reestablishing a stable platele t count, The immediate rise of platelets after administration of predn isolone supports the pathophysiological view of hantavirus infection a s an immunologically mediated disease, Corticosteroids in the treatmen t of hantavirus-associated thrombocytopenia might need further systema tic evaluation, (C) 1998 by the National Kidney Foundation, Inc.