Authors reply: Distinguishing between hantavirus-induced haemorrhagic fever with renal syndrome and pregnancy-induced liver pathologies (AFLP and HELLP syndromes).

To the editor: We thank Clement et al. for their interest in our work [1] and for questioning the diagnostic sequence and management of such a complex clinical and biological situation. During pregnancy, diagnosis of haemorrhagic fever with renal syndrome (HFRS) caused by hantaviruses, including Seoul virus (SEOV), can easily be missed due to its rarity and its ‘pseudo-vasculoplacental’ clinical presentation. Distinguishing between hantavirus infection and certain liver pathologies of pregnancy, especially severe preeclampsia with haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome and acute fatty liver of pregnancy (AFLP), can be problematic.