A 35-year-old man with influenza-like symptoms, thrombocytopenia and acuterenal failure

Hemorrhagic fever with renal syndrome is caused by infection with certain h antavirus subtypes. In Germany the prevailing hantavirus serotype Puumala t ends to produce nephropathia epidemica, a mild form of hemorrhagic fever wi th renal syndrome, while Hantaan-serotype infection has been rarely found. Schleswig-Holstein is not an endemic focus for hantavirus infections. We re port a 35-year-old man, who was admitted to hospital with acute renal failu re. Renal biopsy findings and measurement of acute-phase proteins in the ur ine indicated acute vasculitis, while serological examinations revealed a H antaan-serotype infection. The renal function recovered spontaneously after a short period of hemodialysis treatment. Conclusions: 1. We could diagnos e a case of nephropathia epidemica, which was associated with a Hantaan-lik e serotype. 2. Hantavirus infections are an important alternative for diffe rential diagnosis of acute renal failure also in nonepidemic focuses. 3. Th e findings of the renal biopsy and measurement of proteins in the urine may support the hypothesis, that hantavirus infection may be the initiating ev ent in triggering a systemic vasculitis.