Rare case of intracranial hemorrhage associated with seoul virus infection diagnosed by metagenomic next‐generation sequencing

Abstract

Background Seoul virus (SEOV) is a Hantavirus and the causative pathogen of Hemorrhagic Fever with Renal Syndrome (HFRS). Diagnosing SEOV infection is difficult because the clinical presentations are often undistinguishable from other viral or bacterial infections. In addition, diagnostic tools including serological and molecular assays are not readily available in the clinical settings. Case Report A 57‐year‐old male presented with fever and a sudden loss of consciousness in November 2019. Computed tomography (CT) scan showed subdural hematoma, subfalcine herniation, and brain infarction. He developed thrombocytopenia and elevated transaminases, but no rashes or obvious kidney damage. He reported having a rat bite. HFRS was suspected. The Hantavirus IgG was positive, and the metagenomic next‐generation sequencing (mNGS) detected SEOV sequences directly in the blood. Conclusion This report highlights the importance of suspecting SEOV infection in febrile patients with thrombocytopenia and elevated liver enzymes despite the absence of hemorrhagic manifestations of skin and renal syndromes. Next‐generation sequencing is a powerful tool for pathogen detection. Intracranial hemorrhage and brain infarction as extrarenal manifestations of HFRS are rare but possible as demonstrated in this case.

A case report of diagnosis of cat-scratch disease using metagenomic next-generation sequencing

“…However, the evaluation of lymph node biopsy samples indicated a possible case of CSD; Further analysis using mNGS confirmed the presence of B. henselae in the lymph nodes ( Yang et al., 2020 ). In addition, visceral leishmaniasis ( Chen H. et al., 2020 ), psittacosis ( Chen X. et al., 2020 ), and Seoul virus ( Xie et al., 2021 ) have been detected using mNGS. Qian et al.…”

“…However, the evaluation of lymph node biopsy samples indicated a possible case of CSD; Further analysis using mNGS confirmed the presence of B. henselae in the lymph nodes (Yang et al, 2020). In addition, visceral leishmaniasis (Chen H. et al, 2020), psittacosis , and Seoul virus (Xie et al, 2021) have been detected using mNGS. Qian et al suggest that the prompt application of mNGS may be helpful in diagnosing suspected infections caused by a combination of different or uncommon pathogens.…”

Hantavirus infection-related acute inflammatory demyelinative polyradiculoneuropathy: A case report and literature review

“…Fever, thrombocytopenia, acute kidney injury and proteinuria are the characters of hemorrhagic fever with renal syndrome (HFRS). Hantavirus infection was also involved in central/ peripheral nervous system disorder, including encephalitis [1][2][3][4][5] and pituitary glands injury/hypopituitarism, [6][7][8][9][10][11][12][13][14][15] Guillain-Barre syndrome (GBS) [9,[16][17][18][19] and acute-onset chronic inflammatory demyelinating polyneuropathy. [20] Imaging is nonspecific but helpful for diagnosis and differential diagnosis.…”

Expression of the α7 nAChR Subunit Duplicate Form (CHRFAM7A) Was Down-Regulated in Patients with Intracranial Infection and Reduced Inflammation in in vitro Model by p38 MAPK

“…Internal infection after neurosurgical craniotomy is a serious neurosurgical complication which can lead to serious sequelae and even endanger the life of patients [1]. Normal brain tissues are protected by meninges, skulls, and scalp, and the risk of infection is low [1]. However, craniotomy destroys the above protection and increases the risk of internal infection.…”