[Thrombocytopenia and acute kidney injury]

A 31-year old man is addressed to the emergency department for fever, abdominal pain and vomiting. Laboratory tests reveal an inflammatory syndrome, thrombocytopenia, acute kidney injury associated with major proteinuria (more than 3 g/24 h). Evaluation will conclude to an acute interstitial nephritis and the serology is positive for Hantavirus. This clinical case illustrates differential diagnosis of acute renal failure and reminds the theory of hemorrhagic fever with renal syndrome : usual clinical presentation is "flu"-like symptoms, thrombocytopenia and acute renal failure. Hantavirus is endemic in some area in Europe and in Belgium. This clinical presentation should suggest the diagnosis if the patient has stayed in an endemic area.