Ulcerative Lesions with Hemorrhage in a Patient with Severe Fever with Thrombocytopenia Syndrome Observed via Upper Gastrointestinal Endoscopy

Abstract

SUMMARY: Severe fever with thrombocytopenia syndrome (SFTS) is a novel bunyavirus infection caused by the SFTS virus (SFTSV, family Bunyaviridae, genus Phlebovirus) with a high case fatality rate. A previously healthy 72-year-old man showed symptoms of fever, general fatigue, and altered consciousness. He was hospitalized for treatment. On day 3, considering the day on which fever appeared first during the disease course as day 0, he had bloody emesis. An emergency upper gastrointestinal endoscopic examination revealed multiple ulcerative lesions with continuously oozing hemorrhage in the stomach. He died on day 7. He was retrospectively diagnosed as having SFTS, Although it was less likely that the gastric ulcerative lesions were directly induced by SFTSV replication, it was evident that hemorrhagic emesis might occur in the patient in association with the pathophysiology of SFTS. The real-time imaging of gastric ulcerative lesions in a patient with SFTS is reported.

Severe Fever with Thrombocytopenia Syndrome Phlebovirus causes lethal viral hemorrhagic fever in cats

“…These lesions in the fatal cats were quite similar to those in SFTS patients 19 . However, the lesions in the gastrointestinal tract were more severe than those reported in SFTS patients 20 .…”

Pathophysiology of severe fever with thrombocytopenia syndrome and development of specific antiviral therapy

“…Severe necrotizing lymphadenitis with massive necrosis, depletion of small lymphocytes, and severe infiltration of the swollen right axillary and right cervical lymph nodes by histiocytes and immunoblasts were also observed [4]. Gastric ulceration, as was also reported in a case by [22], was also noted in the pyloric region ( Fig. 3C), and hemorrhage was present in the colon and lung ( Fig.…”

“…Most patients show thrombocytopenia and leukopenia in their total blood cell counts. One patient with hematemesis, who was examined by gastrointestinal endoscopy to determine the cause of hemorrhage, had multiple ulcerative gastric lesions from which hemorrhagic oozing occurred [22].…”

Histopathological Characterization of Cases of Spontaneous Fatal Feline Severe Fever with Thrombocytopenia Syndrome, Japan

“…Gastrointestinal manifestation is one of the clinical features of human SFTS (1-4). A lethal case of Spontaneous Fatal Feline SFTS, Japan severe intestinal hemorrhage and another case of multiple gastrointestinal ulceration have been reported in humans (20,26). However, the incidence of these lesions is unclear because cases without obvious intestinal findings also have been reported (21).…”