Leukemoid Reaction in Complicated Haemorrhagic Fever with Renal Syndrome

Hantaan Virus (HTNV) infections are mostly associated with fever, haemorrhagic and renal manifestations, known as Haemorrhagic Fever with Renal Syndrome (HFRS). We herein describe three cases with acute HTNV infection, confirming that HTNV infection may cause leukemoid reaction and prominent liver involvement, along with profound thrombocytopenia and mild to severe Acute Kidney Injury (AKI). These cases highlight the need for considering hantavirus testing in cases of thrombocytopenia, extreme leukocytosis, and fever of unknown origin, especially in areas endemic for the infection.