Abstract
AbstractHemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Approximately 5% of HUS cases are associated with Streptococcus pneumoniae infections (pHUS). Treatment includes supportive care with appropriate antimicrobial therapy, fluid and blood product resuscitation, and renal replacement therapy. We presented a case of a 22-month-old previously healthy girl, who was hospitalized at University Hospital of Split. Left-sided pneumonia and sepsis caused by S. pneumoniae were confirmed. The course of illness was complicated with development of pHUS. Since the pathogenesis of pHUS is only partially understood, the treatment remains controversial. Our patient was successfully treated with daily sequence tandem continuous venovenous hemodiafiltration and therapeutic plasma exchange with albumins, along with other supportive measures. Therefore, in our opinion, plasmapheresis should be considered as a part of standard treatment of children with pHUS. Additionally, the incidence of pHUS appears to be increasing. S. pneumoniae is a particularly important among pediatric pathogens and it can cause wide spectrum of illnesses. Therefore, due to the significant burden of invasive pneumococcal disease, pneumococcal vaccination should be encouraged.
Highlights
In childhood, hemolytic uremic syndrome (HUS) is usually triggered by infection and is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI)
We present the first pediatric case of pHUS treated with sequence tandem continuous venovenous hemodiafiltration and therapeutic plasma exchange in Croatia
Compared with Shiga-like toxin producing Escherichia coli (STEC)-HUS, children affected by pHUS are younger with more severe renal and/or hematological disease, and require longer hospital stays.[6,7]
Summary
Hemolytic uremic syndrome (HUS) is usually triggered by infection and is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). The vast majority of cases are preceded by an intestinal infection caused by Shiga-like toxin producing Escherichia coli (STEC).[1] Atypical HUS (aHUS) is more severe form of HUS that results from the over activation of the alternative complement pathway.[2] Approximately 5% of HUS cases are associated and triggered by Streptococcus pneumoniae infections (pHUS).[3] Characteristics of this severe invasive pneumococcal disease (IPD) complication usually become apparent 3 to 13 days after the onset of pneumococcal-related symptoms.[4] Acute mortality is the highest in patients with S. pneumoniae meningitis complicated by pHUS.[5]. We presented a case of a child with pHUS who was successfully treated with tandem hemodiafiltration and plasma exchange. Written informed consent for the publication of the data was obtained from the patient’s family
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