Abstract: SA-PO0377
Transient Hypocomplementemia in Acute Hantavirus Infection in a Returning Traveler
Session Information
- AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Fraser, Candice Neezeth, University Hospital Limerick, Dooradoyle, County Limerick, Ireland
- Casserly, Liam F., University Hospital Limerick, Dooradoyle, County Limerick, Ireland
Introduction
Hantaviruses are rodent borne zoonoses that cause haemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome, with kidney involvement ranging from mild to severe AKI. They are endemic in parts of Asia, and infection follows exposure to rodent urine, saliva or faeces after an incubation of two to six weeks. Complement activation, endothelial injury and coagulopathy are central to hantavirus pathogenesis, but transient hypocomplementemia with active urinary sediment is not widely recognised in non endemic settings.
Case Description
A 46 year man presented with a two week history of fevers, sore throat, night sweats, myalgia and polyarthralgia after recent travel from Shanghai within the preceding month. Examination revealed a purpuric rash over both lower limbs. Laboratory evaluation demonstrated mild acute kidney injury (creatinine 104 µmol/L, baseline 80), active urine sediment (1+ blood, 2+ protein), thrombocytopenia (47 ×10^9/L) and hypocomplementemia (C3 0.6 g/L, C4 <0.02 g/L) with a negative vasculitis screen. Infectious investigations included hantavirus and dengue serology. Suspecting an infection related, self limiting process, we pursued conservative management without renal biopsy or immunosuppression. Within 72 hours, complement levels and platelets normalised and the urine dipstick became bland; one week later, serology confirmed hantavirus IgM positivity with Panbio dengue IgG positivity.
Discussion
This case highlights transient hypocomplementemia with active urinary sediment in acute hantavirus infection in a returning traveller. The combination of acute kidney injury, thrombocytopenia, purpuric rash and low complement can mimic systemic vasculitis or immune complex glomerulonephritis, but infection related causes such as hantavirus should be considered, particularly with relevant travel and exposure history. Early recognition of this pattern supports conservative, supportive management and may prevent unnecessary renal biopsy and inappropriate immunosuppression. Clinicians should use early hantavirus serology in febrile patients with acute kidney injury and low complement to guide care.