2095 Hemolytic Uremic Syndrome in a Young Female, Later Diagnosed With Crohn's Disease

Abstract

INTRODUCTION: Hemolytic uremic syndrome (HUS) is defined by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. HUS has mostly been associated with Escherichia Coli infection but also seen with systemic infections, pregnancy, rheumatic disease and malignancies. Although, HUS has been described in previously diagnosed case of crohn’s, concomitant occurrence of both is a rarity. We describe a case of 37-year-old female, with acute onset of HUS, who was subsequently diagnosed with crohn's. CASE DESCRIPTION/METHODS: 32-year-old female presented with complaints of abdominal pain, and bloody diarrhea for 5 days, which persisted despite antibiotic therapy. In ED, laboratory tests showed anemia, thrombocytopenia, AKI and Lactic acidosis. Her hemoglobin dropped to 6.7 g/dl and platelets went down to 48k. LDH was elevated and haptoglobin was low. Peripheral smear showed moderate schistocytes. However, shiga toxin was negative. Patient was managed symptomatically for HUS but her symptoms persisted. Imaging revealed thick-walled transverse and left colon. Colonoscopy showed mucosal ulceration and severe colitis with shallow and deep ulcers in ascending, transverse, and descending colon but rectum was normal. Push enteroscopy revealed a small esophageal ulcer. Biopsy showed granulomatous inflammation suggestive of Crohn's. Hence the patient was started on sulfasalazine. Patient had significant clinical recovery within a month and repeat colonoscopy showed healing congested mucosa. DISCUSSION: Although HUS is predominantly described in the pediatric population, its incidence is rising in adult population. It has been found to involve the transverse and ascending colon, much like Crohn's disease. A few reported cases has showed interchanging clinical features between HUS and IBD. Cumulative occurrence of the both was considered rare, however, cases of HUS in patient who were already diagnosed with Crohn's has been seen. In this case, the patient presented with the clinical features of HUS as her first and only manifestation of her Crohn's. Rapid recovery and resolution of symptoms within four weeks of starting the appropriate treatment presents the importance of the appropriate management on the clinical recovery. Hence, with the growing incidence of concurrent occurrence of both entities, early colonoscopy with biopsy can be beneficial in cases of HUS not responding to treatment, even if the patient has no history of IBD, as this could be their first presentation.