TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Hantavirus pulmonary syndrome (HPS) is a rare but potentially life-threatening viral illness transmitted to humans from the infected urine, droppings or saliva of certain species of mice and rats. 728 cases have been reported so far since surveillance in the United States began in 1993 [1]. Most cases (93%) have occurred in states west of the Mississippi River. We present a case of a young male who presented with Hantavirus pulmonary syndrome. CASE PRESENTATION: 28 year old male from rural Texas presented with 1 week of intractable nausea and vomiting. He initially presented to an outside ER where he was found to be hypoxic requiring supplemental oxygen and worsening respiratory status and was transferred to our hospital for higher level of care. Initial workup with CT angiogram of chest revealed bilateral infiltrates and bilateral pleural effusions. Patient was initially started on empiric antibiotics and placed on non-invasive ventilation. Influenza and Repeated COVID-19 tests were negative. Patient reported that he lives in rural area and recently had exposure to a dead mouse in one of his house traps. Hantavirus IgG and IgM antibodies were sent which came back positive after patient had been discharged. Patient did well with supportive therapy of gentle diuresis and non-invasive ventilation and was discharged home after 5 days. DISCUSSION: The clinical syndrome of Hantavirus pulmonary syndrome (HPS) was first recognized in 1993. Although rare, it is frequently fatal, with a case fatality rate of 36%. HPS is an acute febrile illness with a prodrome consisting of fever, chills, myalgia, headache, and gastrointestinal symptoms. One or more of the following clinical features must be present:• Bilateral diffuse interstitial edema• Clinical diagnosis of acute respiratory distress syndrome (ARDS)• Radiographic evidence of noncardiogenic pulmonary edemaLaboratory criteria for diagnosis include detection of hantavirus-specific immunoglobulin M or rising titers of hantavirus-specific immunoglobulin G. CONCLUSIONS: Patients infected with Hantavirus pulmonary syndrome do better if they are recognized early and treated in Intensive care unit. There is no specific treatment or vaccine available at this point. Supplemental oxygen and intubation and mechanical ventilation for severe respiratory failure remains the standard of care. REFERENCE #1: https://www.cdc.gov/hantavirus/hps/index.html DISCLOSURES: No relevant relationships by Anam Hassan, source=Web Response No relevant relationships by Muhammad Hasham Sarwar, source=Web Response No relevant relationships by Brian Williams, source=Web Response