The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic
has refocused scientific interest on gaining insight into the pathophysiology of systemic
viral diseases. Complement activation has been characterized as a driver of endothelial
injury and microvascular thrombosis in acute respiratory distress syndrome as well
as hantavirus hemorrhagic fever with renal syndrome. On this occasion, we wish to
report a case of severe hantavirus disease with coinciding SARS-CoV-2 infection mimicking
thrombotic microangiopathy with rapid response of inflammatory markers, hematologic
parameters and proteinuria to eculizumab. These findings support a disease model of
virus-associated endothelial injury involving alternative pathway complement activation.
Future studies are needed to explore whether end organ damage can be mitigated by
complement inhibition in life-threatening viral disease.
