{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T21:00:33Z","timestamp":1782421233572,"version":"3.54.5"},"reference-count":10,"publisher":"SMC Media","issue":"5","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction:\u00a0Hantavirus infection is an uncommon zoonosis in Europe but remains an important cause of acute kidney injury, particularly in patients with environmental exposure to rodents. Renal involvement is the hallmark of the disease, although pulmonary manifestations may coexist and mimic immune-mediated pulmonary\u2013renal syndromes, leading to diagnostic challenges in internal medicine. Case description:\u00a0A 46-year-old previously healthy man living in a rural area was admitted for acute febrile illness with asthenia and myalgia. Initial investigations revealed severe thrombocytopenia and acute kidney injury with proteinuria and microscopic haematuria. A computed tomography scan of the chest and abdomen showed bilateral pulmonary abnormalities, consistent with an acute pulmonary\u2013renal syndrome. Extensive immunological and infectious investigations excluded autoimmune disease and alternative infectious causes. Hantavirus infection was confirmed by positive IgM and IgG serology, with molecular identification of Puumala virus. Renal biopsy demonstrated moderate acute tubular necrosis with minimal interstitial inflammation and preserved glomeruli. The patient was treated with supportive care only, resulting in rapid clinical improvement and complete recovery of renal function. Conclusion:\u00a0Hantavirus infection should be considered in patients presenting with acute pulmonary\u2013renal syndrome, thrombocytopenia, and compatible epidemiological exposure. Early diagnosis allows appropriate supportive management, avoids unnecessary immunosuppressive therapy, and is associated with an excellent renal prognosis in Puumala virus infection.<\/jats:p>","DOI":"10.12890\/2026_006159","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T12:03:33Z","timestamp":1776773013000},"source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic and clinical challenges of hantavirus-associated acute kidney injury"],"prefix":"10.12890","volume":"13","author":[{"given":"Nouha","family":"Ghriss","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile de France, Melun, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Mussini","sequence":"first","affiliation":[{"name":"Pathology Department, Assistance Publique des H\u00f4pitaux de Paris, Bic\u00eatre Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Kammoun","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile de France, Melun, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chadi","family":"Azar","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile de France, Melun, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Leroy","sequence":"first","affiliation":[{"name":"Public Health Unit, Groupe Hospitalier Sud Ile de France, Melun, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franck","family":"Pourcine","sequence":"first","affiliation":[{"name":"Department of Nephrology, Groupe Hospitalier Sud Ile de France, Melun, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabil","family":"Belfeki","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile de France, Melun, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10397","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"10.12890\/2026_006159_ref1","doi-asserted-by":"crossref","unstructured":"Abdoler EA, Malani PN. What Is Hantavirus? JAMA 2025;334:98. doi: 10.1001\/jama.2025.5014","DOI":"10.1001\/jama.2025.5014"},{"key":"10.12890\/2026_006159_ref2","doi-asserted-by":"crossref","unstructured":"Tkachenko E, Dzagurova T, Galieva G, Ivanis V, Kurashova S, Tkachenko P, et al. Clinical Manifestations of Hemorrhagic Fever with Renal Syndrome, Various Nosologic Forms and Issues of Hantavirus Infections Terminology. Viruses 2025;17:578. doi: 10.3390\/v17040578","DOI":"10.3390\/v17040578"},{"key":"10.12890\/2026_006159_ref3","doi-asserted-by":"crossref","unstructured":"Sehgal A, Mehta S, Sahay K, Martynova E, Rizvanov A, Baranwal M, et al. Hemorrhagic Fever with Renal Syndrome in Asia: History, Pathogenesis, Diagnosis, Treatment, and Prevention. Viruses 2023;15:561. doi:10.3390\/v15020561","DOI":"10.3390\/v15020561"},{"key":"10.12890\/2026_006159_ref4","doi-asserted-by":"crossref","unstructured":"Tortosa F, Perre F, Tognetti C, Lossetti L, Carrasco G, Guaresti G, et al. Seroprevalence of hantavirus infection in non-epidemic settings over four decades: a systematic review and meta-analysis. BMC Public Health 2024;24:2553. doi: 10.1186\/s12889-024-20014-w","DOI":"10.1186\/s12889-024-20014-w"},{"key":"10.12890\/2026_006159_ref5","doi-asserted-by":"crossref","unstructured":"Reynes JM, Carli D, Thomas D, Castel G. Puumala Hantavirus Genotypes in Humans, France, 2012-2016. Emerg Infect Dis 2019;25:140\u2013143. doi: 10.3201\/eid2501.180270","DOI":"10.3201\/eid2501.180270"},{"key":"10.12890\/2026_006159_ref6","doi-asserted-by":"crossref","unstructured":"Koehler FC, Di Cristanziano V, Sp\u00e4th MR, Hoyer-Allo KJR, Wanken M, M\u00fcller RU, et al. The kidney in hantavirus infection\u2014epidemiology, virology, pathophysiology, clinical presentation, diagnosis and management. Clin Kidney J 2022;15:1231\u20131252. doi: 10.1093\/ckj\/sfac008","DOI":"10.1093\/ckj\/sfac008"},{"key":"10.12890\/2026_006159_ref7","doi-asserted-by":"crossref","unstructured":"Connolly-Andersen AM, Sundberg E, Ahlm C, Hultdin J, Baudin M, Larsson J, et al. Increased Thrombopoiesis and Platelet Activation in Hantavirus-Infected Patients. J Infect Dis 2015;212:1061\u20131069. doi: 10.1093\/infdis\/jiv161","DOI":"10.1093\/infdis\/jiv161"},{"key":"10.12890\/2026_006159_ref8","doi-asserted-by":"crossref","unstructured":"Lupusoru G, Lupusoru M, Ailincai I, Bernea L, Berechet A, Spataru R, et al. Hanta hemorrhagic fever with renal syndrome: A pathology in whose diagnosis kidney biopsy plays a major role (Review). Exp Ther Med 2021;22:984. doi: 10.3892\/etm.2021.10416","DOI":"10.3892\/etm.2021.10416"},{"key":"10.12890\/2026_006159_ref9","doi-asserted-by":"crossref","unstructured":"Krautkr\u00e4mer E, Zeier M, Plyusnin A. Hantavirus infection: an emerging infectious disease causing acute renal failure. Kidney Int 2013;83:23\u201327. doi: 10.1038\/ki.2012.360","DOI":"10.1038\/ki.2012.360"},{"key":"10.12890\/2026_006159_ref10","doi-asserted-by":"crossref","unstructured":"Laine O, Lepp\u00e4nen I, Koskela S, Antonen J, M\u00e4kel\u00e4 S, Sinisalo M, et al. Severe Puumala virus infection in a patient with a lymphoproliferative disease treated with icatibant. 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