Abstract
Hantavirus cardiopulmonary syndrome (HCPS) is associated with rapid cardiopulmonary collapse from endothelial injury, resulting in massive capillary leak, shock and severe hypoxemic respiratory failure. To date, treatment remains supportive and includes mechanical ventilation, vasopressors and extracorporeal membrane oxygenation, with mortality approaching 50%. Two HCPS survivors initially given drotrecogin alpha (activated) (DAA) for presumed bacterial septic shock are described. Vasoactive medications were required for a maximum of 52 h, whereas creatinine levels and platelet counts normalized within seven to nine days. Given the similar presentations of HCPS and bacterial septic shock, empirical DAA therapy will likely be initiated before a definitive diagnosis of HCPS is made. Further observations of DAA in HCPS seem warranted.
Highlights
Hantavirus cardiopulmonary syndrome (HCPS) is associated with rapid cardiopulmonary collapse from endothelial injury, resulting in massive capillary leak, shock and severe hypoxemic respiratory failure
HCPS may be indistinguishable from bacterial septic shock with adult respiratory distress syndrome (ARDS)
We report two HCPS survivors given drotrecogin alpha activé (DAA) before their HCPS diagnoses were confirmed as part of an open-label preapproval drug access study with proxy consent
Summary
Drotrecogin alpha (activated) in two patients with the hantavirus cardiopulmonary syndrome. CASE PRESENTATIONS Patient 1: Acute physiology and chronic health evaluation (APACHE) II score 29 (67.2% predicted mortality) In November 2001, a 46-year-old previously healthy woman presented with a seven-day history of malaise, headache and myalgia She developed rapidly progressive hypoxemic respiratory failure associated with a nonproductive cough. He was intubated and ventilated with low tidal volumes Within hours, he developed hypotension and oliguric renal failure (creatinine level of 176 μmol/L), requiring a 20 μg/min noradrenaline infusion. He developed hypotension and oliguric renal failure (creatinine level of 176 μmol/L), requiring a 20 μg/min noradrenaline infusion His oxygenation did not improve (PO2 of 55 mmHg) on a fraction of inspired O2 of 1.0 and positive end-expiratory pressure of 20 cmH2O. He was IgM-positive and IgG-positive for the Sin Nombre hantavirus, and otherwise had negative culture results
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