A Rare But Important Disease Resembling Adult Respiratory Distress Syndrome (ARDS)

1Faith Regional Health Services, Norfolk, NE

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 174

Case Presentation:

A 50‐year‐old previously healthy man from a rural area in the Midwest initially felt feverish and had generalized body aches for 2 days. On the third day he developed mild dry cough with some shortness of breath that progressed rapidly in the next 24 hours, and he was rushed to the nearest rural health center. He was found to be severely hypoxic at that time and was transferred to the hospitalist service at the regional hospital. He was admitted to the ICU and was started on mechanical ventilation. He required 100% FiO2 and a PEEP of 12 to maintain a saturation of 88%‐90%.The physical exam was only remarkable for bilaterally diminished breath sounds. CXR showed bilateral pulmonary infiltrates, suggesting ARDS. His total WBC count was 19,500 with 34% bands, platelets were 19,000, Hg was 21.7 g, LDH was 484 U/L, PT was 15.9 seconds, and PTT was 81 seconds. He became hypotensive within a few hours of admission, and bedside ECHO showed an ejection fraction of 40% with global hypokinesia. At this point, the constellation of findings (rural setting, prodromal phase, thrombocytopenia, leukocytosis, and bilateral pulmonary infiltrates) aroused suspicion for hantavirus cardiopulmonary syndrome (HCPS), and antibodies for hantavirus were sent. The patient's condition continued to deteriorate despite full resuscitative efforts, and he died within 36 hours of admission. The next day, the antibodies came back positive. The state heath department was immediately notified about this case of fatal HCPS, and diagnosis was later confirmed by the Centers for Disease Control and Prevention with quantitative IgG and IgM antibodies.

Discussion:

Hantavirus is a zoonotic virus transmitted by rodents. There have been a total of 465 confirmed cases of HCPS in 30 states since case counting started in the United States. Of the 465 cases, 165 (35%) were fatal. Clinically HCPS is characterized by a relatively short (2‐ to 3‐day) febrile prodrome that progresses into pulmonary symptoms with bilateral diffuse interstitial edema that may radiographically resemble ARDS. Most patients develop hypotension and progressive evidence of pulmonary edema and hypoxia. Fatal infections appear to have severe myocardial depression. The most important lab findings include severe thrombocytopenia, high LDH, and leukocytosis with significant bandemia. Rising LDH and worsening coagulopathy indicate poor prognosis. No specific antiviral treatments have been approved so far, and the treatment is mainly supportive

Conclusions:

HCPS is usually diagnosed in hospitalized patients admitted for presumed ARDS, and hospitalists can play a great role in early diagnosis and timely reporting of this disease. It is important to consider this diagnosis in previously healthy patients hospitalized with ARDS of unknown etiology. Prompt diagnosis and reporting is the cornerstone in directing state and federal resources to prevent any outbreak of this potentially fatal viral disease

Author Disclosure:

N. Sapkota, MD, none.

To cite this abstract:

Sapkota N. A Rare But Important Disease Resembling Adult Respiratory Distress Syndrome (ARDS). Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 174. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/a-rare-but-important-disease-resembling-adult-respiratory-distress-syndrome-ards/. Accessed July 17, 2019.

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