Puumala hantavirus (PUUV) infections usually show a mild or moderate clinical course, but may sometimes also lead to life-threatening disease. Here, we report on a 60-year-old female patient with common variable immunodeficiency (CVID) who developed a fatal PUUV infection with persistent renal failure, thrombocytopenia, and CNS infection with impaired consciousness and tetraparesis. Hantavirus-specific antibodies could not be detected due to the humoral immunodeficiency. Diagnosis and virological monitoring were based on the quantitative detection of PUUV RNA in blood, cerebrospinal fluid, bronchial lavage, and urine, where viral RNA was found over an unusually extended period of one month. Due to clinical deterioration and virus persistence, treatment with ribavirin was initiated. Additionally, fresh frozen plasma (FFP) from convalescent donors with a history of PUUV infection was administered. Despite viral clearance, the clinical condition of the patient did not improve and the patient died on day 81 of hospitalization. This case underlines the importance of the humoral immune response for the course of PUUV disease and illustrates the need for PCR-based virus diagnostics in those patients. Due to its potential antiviral activity, convalescent plasma should be considered in the therapy of severe hantavirus diseases.

During the coronavirus disease 2019 (COVID-19) pandemic multiple attempts of passive immunization with plasma from convalescent patients have been made to improve morbidity and mortality [1, 2]. Outcome varies among patient groups, disease severity, dose and time point of infusion. Here, we report on an in-depth analysis of clinical data following CP therapy in severe COVID-19-induced acute respiratory distress syndrome (ARDS). Together with the Fraunhofer Gesellschaft, we conducted a prospective, open-label, randomized, controlled phase 2b clinical trial. Between 15 January 2021 and 31 May 2022, 53 patients in four intensive care units in Germany were randomized, 26 to receive convalescent plasma in addition to standard of care (CP + SOC) and 27 to receive SOC alone [3]. Detailed information regarding trial design, patients, and interventions is presented in the supplementary appendix. Participation was restricted to 72 h after mechanical ventilation initiation which resembles early administration regimes in other trials [2]. Baseline characteristics are shown in electronic supplementary Table S1. Patients in the CP + SOC group received three consecutive infusions of plasma every 12 h immediately after randomization. Transfusion was

Postpump chorea is a rare hyperkinetic movement disorder following cardiac surgery with cardiopulmonary bypass. Although initially described in pediatric patients, postpump chorea is increasingly recognized in adults. We report the case of a 65‐year‐old woman who developed severe choreiform movements approximately 2 weeks after cardiac surgery. Extensive diagnostic workup including cerebrospinal fluid analysis revealed no alternative etiology. Notably, hypothermia had only been mild during cardiac surgery, and there were no characteristic basal‐ganglia MRI abnormalities. Treatment with tiapride, a selective dopamine D2/D3 receptor antagonist with established antichoreic effects was followed by rapid neurological improvement and complete remission of symptoms. This is one of the first reports of tiapride in adult postpump chorea, supporting its role as a potentially useful symptomatic therapeutic option in this rare complication.

Background: Cardiac surgery using cardiopulmonary bypass uses controlled hypoperfusion which leads to relative organ damage. Acute kidney injury is the most frequent and most important organ failure, in particular in patients with chronic kidney disease. To date, there are no approved drug treatments that could effectively prevent acute kidney injury. SP16, an agonist of the low-density lipoprotein receptor-related protein 1, has been shown to exert both kidney- and cardioprotective effects in preclinical trials. Early clinical use of SP16 in phase I trials was safe. Administration of SP16 had beneficial trends on inflammatory response and infarct size in patients with ST-segment elevation myocardial infarction. The primary objective of this phase IIa trial is to demonstrate that injection of SP16 is safe and superior to placebo in preventing cardiac surgery-associated acute kidney injury within 7 days after surgery. Methods: This randomised, double-blinded, placebo-controlled, single-centre study evaluates the efficacy and safety of SP16 in 120 high-risk chronic kidney disease patients with disease stage G2-G3b undergoing cardiac surgery who are randomised into one of two treatment groups in a 1:1 ratio: SP16 (12 mg) or placebo. The study medication is administered via two subcutaneous injections, with the first dose given before surgery, followed by an additional dose after 9 h. Primary endpoints are the incidence of acute kidney injury during 7 days post-surgery and the frequency of adverse events within 72 h after index surgery. Important secondary endpoints include the incidence of major adverse kidney events at day 90 and impact on cardiac function. Safety assessments encompass adverse events, vital signs, electrocardiograms and routine safety laboratory tests. Additional evaluations include pharmacokinetics and immunological biomarkers. Discussion: This single-centre phase IIa trial will assess the incidence of cardiac surgery-associated acute kidney injury, describing the kidney-protective potential of SP16 and its safety profile in patients undergoing cardiac surgery. Trial registration: EUCT, EUCT number 2025-522491-89-00. Registered on February 2, 2026, https://euclinicaltrials.eu/ctis-public/view/2025-522491-89-00 . Patient recruitment is planned to start on August 1, 2026.

Background: In the presence of clinical or microbiological evidence of pneumonia, emerging leukocytes in recovery from neutropenia undergo substantial migration to the site of infection, where they elicit immunogenic reactions. The administration of granulocyte colony-stimulating factors is a risk factor for dysregulation of this immune response, which can lead to ARDS. However, there is a paucity of knowledge regarding the severe forms of near-fatal IRIS. Case presentation: This case report describes the successful treatment of a hematologic patient with life-threatening Immune Reconstitution Inflammatory Syndrome after recovery from neutropenia and a subsequent acute respiratory distress syndrome involving cytokine adsorption. The present report delineates the case of a 65-year-old male afflicted with plasmoblastic lymphoma and neutropenic sepsis with pneumonia. Escherichia coli was identified in bronchoalveolar lavage fluids, and the patient was successfully treated with piperacillin and tazobactam. After recovering from neutropenia, the patient's respiratory function abruptly worsened, resulting in a secondary, severe ARDS. This deterioration was accompanied by increasing interleukin-6 levels. Therapeutic approaches as prone positioning or volume depletion using renal replacement therapy with high ultrafiltration rates did not lead to a significant respiratory improvement. Initiation of cytokine adsorption resulted in an immediate and absolute respiratory recovery. Conclusions: Immune reconstitution inflammatory syndrome might cause dysregulated pulmonary immune responses following recovery from neutropenia with consecutive severe ARDS. This case report is the first to link IRIS-induced severe ARDS to a hyperinflammatory condition and to the successful therapeutic approach of cytokine adsorption. Ultimately, only cytokine adsorption was able to rapidly improve this suspected IRIS-associated hyperinflammation in an otherwise life-threatening ARDS.