Persistent Vomiting Research Articles

Gastric antral web presenting with esophageal stricture and severe malnutrition

Gastric antral web is a rare cause of gastric outlet obstruction in children. Common complaints include intermittent non-bilious vomiting, bloating, pain, loss of appetite, and weight loss. Herein, we report a case of gastric antral web presenting with esophageal stricture and malnutrition, which was followed for many years with a misdiagnosis. An 8-year-old African boy was referred to our pediatric gastroenterology clinic due to recurrent vomiting and severe malnutrition. According to his medical history, the patient began experiencing non-bilious vomiting at 40 days of age and a diagnosis of gastroesophageal reflux was made. He was hospitalized multiple times and received nasogastric tube feedings in the following 4 years. He was re-evaluated for growth retardation and malnutrition at 4 years of age. He had been diagnosed with gluten enteropathy and was fed a gluten-free diet. Recently, he developed difficulty swallowing solid food and was only able to consume liquid meals. Esophagography revealed segmental stenosis in the distal portion of the esophagus. After stricture excision with thoracotomy, upper gastrointestinal series with a radiopaque substance indicated normal esophageal passage; however, prolonged gastric emptying time was also noted. Upon examination during laparotomy, a congenital web was detected in the antral region and was excised. Esophageal and gastric pathologies were consistent with stricture caused by reflux esophagitis and gastric antral web. Today, gastric antral web is mostly diagnosed and treated in infancy. Near total obstruction is relatively easy to diagnose; however, many patients with partial obstruction are followed-up for years with an incorrect diagnosis. Therefore, it should be considered in such cases, persistent vomiting and gastroesophageal reflux may be associated with esophageal stricture.

A 6-month-old patient with cleft lip palate, atrial septal defect, and presenting hyperkalemia: a case report

Introduction: Cleft Lip Palate (CLP) is a prevalent congenital anomaly in Indonesia. Gradual surgery is the gold standard treatment for the condition. However, screening for other comorbidities must be conducted before the surgery. Congenital heart Defects (CHDs) are one of the prevalent concurrent conditions of CLP patients. One of the CHD that can be found is Atrial Septal Defect (ASD). Moreover, electrolyte levels must also be assessed and treated if abnormal before surgery. Hyperkalemia is a type of electrolyte imbalance that can be found, possibly caused by increased potassium load or decreased excretion. Case description: A 6-month-old girl was admitted to our hospital with a fever and dehydration. She complained of persistent vomiting. She had a history of CLP and CHD since birth. The echocardiogram revealed Small Secundum ASD. Laboratory results showed an elevated potassium (5.52 mEq/l). The patient was planned to get primary cleft lip repair and tip rhinoplasty. The surgery was postponed due to the patient’s condition and laboratory findings. During hospitalization, she received electrolyte imbalance correction and symptomatic treatment. A 1-week follow-up assessment showed stable condition, and the patient continued to prepare for the surgery. Conclusion: ASD is frequently observed as one of the most prevalent comorbidities of a CLP patient. Dehydration can increase the potassium level of the blood, and it must be treated before the surgical procedure for CLP patients with ASD condition.

Excessive pickle consumption: beware of adrenal crisis

Adrenal insufficiency (AI) is one of the most life-threatening disorders resulting from adrenal cortex dysfunction. Symptoms and signs of AI are often nonspecific, and the diagnosis can be missed and lead to the development of AI with severe hypotension and hypovolemic shock.We report the case of a 13-year-old child admitted for cardiac arrest following severe hypovolemic shock. The patient initially presented with isolated mild abdominal pain and vomiting together with unexplained hyponatremia. He was discharged after an initial short hospitalization with rehydration but with persistent hyponatremia. After discharge, he had persistent refractory vomiting, finally leading to severe dehydration and extreme asthenia. He was admitted to pediatric intensive care after prolonged hypovolemic cardiac arrest with severe anoxic encephalopathy leading to brain death. After re-interviewing, the child's parents reported that he had experienced polydipsia, a pronounced taste for salt with excessive consumption of pickles lasting for months, and a darkened skin since their last vacation 6 months earlier. A diagnosis of autoimmune Addison's disease was made.Primary AI is a rare life-threatening disease that can lead to hypovolemic shock. The clinical symptoms and laboratory findings are nonspecific, and the diagnosis should be suspected in the presence of unexplained collapse, hypotension, vomiting, or diarrhea, especially in the case of hyponatremia.

Child with Closed Head Injury and Persistent Vomiting.

We present the case of a six-year-old child with autism who presented with persistent vomiting in the setting of a closed head injury (CHI). Computed tomography of the head was normal, but due to persistent vomiting a radiograph of the abdomen was done, which showed multiple, rare-earth magnets in the abdomen. There was no history of witnessed ingestion. These magnets had caused enteroenteric fistula formation leading to persistent vomiting. In the setting of CHI, vomiting can be a sign of concussion or intracranial hemorrhage. In cases of CHI where intracranial pathology is ruled out and vomiting still persists, it is important to explore intra-abdominal causes of vomiting, especially in developmentally challenged children as they have higher incidence of unwitnessed foreign body ingestions.

Cannabinoid hyperemesis syndrome: a case report and literature review

IntroductionCannabis is the most used recreational drug worldwide. Cannabinoids have long been known for their anti-emetic properties. Paradoxically, chronic cannabis consumption has been linked to inducing refractory nausea and vomiting, a condition called cannabinoid hyperemesis syndrome (CHS). CHS remains inadequately acknowledged by clinicians.ObjectivesReport a CHS case and discuss this syndrome’s diagnosis, pathophysiology, and management.MethodsCollection of clinical information and review of the literature.ResultsWe share the case of a 38-year-old male who repeatedly recured to the emergency department (ED) due to persistent vomiting, nausea, and abdominal pain. The patient had experienced similar intermittent episodes over the past 12 years. Interestingly, the use of hot showers provided symptomatic relief. Urine drug tests consistently showed positive results for cannabinoids. During acute phases, he required supportive treatment involving fluid therapy. Long-term treatment included cannabis abstinence. CHS is defined by episodic vomiting, following prolonged excessive cannabis consumption, which is alleviated by sustained cessation of cannabis. During the acute phase of the condition, patients often find relief using hot baths and showers, which is a common behavior observed. CHS-related complications encompass acute kidney injury and severe electrolyte disturbances. CHS can result in multiple ED visits, frequent hospitalizations, extensive diagnostic evaluations, and elevated healthcare expenditures. Although the exact pathophysiology of CHS remains unclear, some mechanisms have been proposed. These include reduced gastric motility by gastrointestinal cannabinoid receptors 1 (CB1) overriding, cannabinoid lipid buildup, endocannabinoid system dysregulation, dysregulated stress response, changes in thermoregulation, modifications in the transient receptor potential vanilloid system and genetic polymorphisms in the P450 system. In the acute phase, the foremost concern is providing supportive care including intravenous hydration and electrolyte corrections. The most effective treatment for CHS is cannabis cessation. Nevertheless, there are alternative treatments that have shown promise in alleviating symptoms, such as hot water hydrotherapy, topical capsaicin, haloperidol, benzodiazepines, propranolol and aprepitant.ConclusionsAs cannabis usage becomes increasingly prevalent, it becomes imperative for healthcare providers to acknowledge the long-term effects of cannabinoids, specifically regarding CHS. This diagnosis should be contemplated when evaluating patients who experience recurrent and incoercible vomiting coupled with a history of cannabis consumption. The compulsion to take hot baths or showers can serve as a noteworthy indicator for diagnosing CHS.Disclosure of InterestNone Declared

A case of pediatric enteroviral meningitis with a travel history

Enterovirus meningitis represents a common cause of meningitis worldwide. In this case study, a 5-year-old male with a travel history presenting with persistent nausea, vomiting, fever and headache for 3 days is reported. The patient described a fever of 39.5°C on the first day of symptom onset as well as decreased appetite and pain in the front right side of head. In physical examination, initially there was no sign of stiff neck, however he had neck stiffness the following day, Kernig's sign and Brudzinski's signs were positive. On admission, blood tests showed a slightly increased C-reactive protein and a normal white cell count. He was admitted to the pediatrics service and a lumbar puncture was performed. Intravenous ceftriaxone and acyclovir were empirically administered. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, with normal protein and glucose concentration. CSF molecular analysis was positive for enterovirus RNA. Cranial magnetic resonance imaging with contrast was normal. Following confirmed diagnosis, ceftriaxone and acyclovir treatments were discontinued and he was given supportive care. He successfully recovered and was discharged without any complication. This case report highlights that rapid molecular testing favorably impacts patient management by improving antimicrobial stewardship through the reduction of intravenous therapy, side effects and inpatient bed-days.

Dengue Hemorrhagic Fever: Risk Factors in Pakistani Cohort

Background: Dengue fever is a mosquito-borne infectious disease with potential complications such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) and has fatality risk of greater than 20% if left untreated. There is lot of heterogeneity in factors predicting development of DHF in different populations. Objective: To determine clinical, biochemical and radiological parameters associated with risk of developing DHF in Pakistani population. Methods: This prospective observational study was conducted in Jinnah Hospital Lahore from October 2022 to December 2022. 180 patients with confirmed Dengue fever were included. Detailed history, clinical examination and laboratory/radiological investigations were performed. Patients were followed for development of DHF. Univariate analysis followed by logistic regression analysis was used to determine independent predictors for DHF. Results: Among 180 patients with Dengue fever with mean age of 33.04 (+14.12) and male to female ratio of 1.53/1 (109/71), we identified presence of mucosal bleeding {OR 4.7 (95% CI 2.05-10.78)p value <0.000}, abdominal pain {OR 2.73 (95% CI 1.17-4.38)p value 0.013}, persistent vomiting {OR 3.09 (95% CI 1.51-6.34)p value 0.002}, tender right hypochondrium {OR 3.98 (95% CI 1.94-8.16) p value <0.000} and presence of peri-cholecystic fluid {OR 7.78 (95% CI 3.25-18.63)p value < 0.000} to be significantly associated with risk of developing DHF with 83.6% accuracy on logistic regression analysis. Conclusion: Mucosal bleeding, right hypochondrium pain, persistent vomiting and presence of peri-cholecystic fluid in a patient of dengue fever predict risk of developing dengue hemorrhagic fever.

POSTNATAL MOTHERS: KNOWLEDGE OF NEWBORN DANGER SIGNS

Postnatal mothers play a crucial role in the care and well-being of their newborns. Having knowledge about the danger signs that may indicate potential health issues in newborns is essential for early detection and timely intervention. This knowledge can help postnatal mothers ensure the health and safety of their babies. One important aspect of postnatal care is educating mothers about the danger signs that may arise in their newborns. These danger signs can vary from mild to severe and may indicate underlying health conditions that require immediate medical attention. By recognizing these signs, postnatal mothers can seek appropriate medical help and prevent complications. Some common danger signs in newborns include difficulty breathing, persistent high fever, severe jaundice, poor feeding or inability to suckle, persistent vomiting, excessive sleepiness or lethargy, and abnormal movements or seizures. These signs can be indicators of serious health conditions such as respiratory distress, infections, jaundice, or neurological problems.

Oesophageal plasmacytoma in a dog: Outcome following surgical excision guided by computed tomographic features and oesophagoscopy biopsy findings

AbstractA 10‐year‐old, female, spayed golden retriever crossbreed dog was referred for persistent vomiting and hypersalivation after eating. Thoracic radiographs showed a small, circular soft tissue opacityin the region of the mid‐caudal thoracic oesophagus An intraluminal, pedunculated mid‐caudal thoracic oesophageal mass was identified on subsequent computed tomography of the thorax. Oesophagoscopy guided endoscopic biopsies were consistent with a plasmacytoma, a neoplasm rarely diagnosed in the canine oesophagus. Thoracotomy via a rib pivot method, longitudinal oesophagotomy and partial longitudinal oesophagectomy were performed with successful mass excision. Histopathology confirmed the diagnosis of plasmacytoma excised with complete surgical margins, and the dog's clinical signs resolved. Repeat computed tomography and oesophagoscopy 7 months following surgical excision showed no recurrence, and the dog remained clinically well.

Neonatal Gastrointestinal Emergencies

Background: Neonatal gastrointestinal emergencies refer to a set of life-threatening conditions affecting the digestive system of a newborn within the first 28 days of life and often associated with high morbidity and mortality. As such, these conditions require immediate and accurate diagnosis as well as proper treatment to optimize the outcomes of these patients. This condition has the potential to obstruct the flow of gastric content leading to vomiting, failure to thrive, and electrolyte imbalances. Discussion: Gastrointestinal obstruction is one of the most common conditions causing emergency condition in neonates. This condition may occur anywhere between the upper part of gastrointestinal tract to the lower gastrointestinal tract. In most cases of neonatal gastrointestinal emergencies, patients almost always present with vomiting that may be bilious or non-bilious. Furthermore, persistent vomiting may also lead to a more severe consequences such as hypovolemic shock and electrolyte imbalances. Therefore, clinicians are expected to address this problem early while also working to find the underlying etiologies of neonatal vomiting. On the other hand, gastrointestinal bleeding is often an alarming sign that indicates a possible emergency condition in neonates. However, some non-emergency condition such as swallowed maternal blood and cow's milk allergy can also result in gastrointestinal bleeding in neonates. Conclusion: Given the critical time window and the vulnerability of the neonate population, the proper identification and prompt treatment of neonatal gastrointestinal emergencies is crucial to minimize morbidity and mortality. Multidisciplinary management with neonatologists, pediatric surgeons, radiologists, and nursing staff working closely together can provide the best possible outcomes.

Jejunoileal atresia and multiple ileal diverticulae in a twelve-day-old infant: A Case Report

A twelve-day-old neonate presented with persistent bilious vomiting and dehydration. A transverse supraumbilical laparotomy was done. Later, he died and autopsy was done. A jejunoileal segment and several other ileal segments were collected. The jejunoileal segment was dilated. It measured 11 cm in length and had a blind end. One of the ileal segments measured 16 cm in length. Ileum showed multiple small diverticulae at the mesenteric border and each diverticula measured 3 to 4 mm in length. Lumen of ileum appeared collapsed or strictured. Further, the lumen of diverticulae contained soft eosinophilic material. He was finally diagnosed as a case of jejunoileal atresia associated with multiple terminal ileal diverticulae. Keywords: Jejunoileal dilatation multiple ileal type IV diverticulosis.

Hypertrophic pyloric stenosis in a toddler: An atypical presentation in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

Gastric outlet obstruction resulting from hypertrophic pyloric stenosis typically manifests in early infancy and seldom occurs after this period. The case is a 14-month-old toddler with multiple episodes of nonbilious, projectile vomiting with persistent hunger, and progressive weight loss for three weeks. The symptoms were preceded by ingestion of a water-based herbal concoction. His barium meal and abdominal ultrasonographic findings were diagnostic of hypertrophic pyloric stenosis (HPS), following which he had an initial pyloromyotomy, which failed before he later had pyloroplasty. The patient was subsequently discharged home four days after the second surgery and has remained stable since then. Although hypertrophic pyloric stenosis is uncommon beyond early infancy, it should be suspected in toddlers with persistent postprandial vomiting that is projectile and nonbilious. Early diagnosis is essential to limit malnutrition as well as other complications associated with HPS.

A curious case of expanded dengue syndrome.

Dengue fever (DF) primarily presents with fever, headache, malaise, bleeding manifestations and haemoconcentration. World Health Organization (WHO) classifies DF according to levels of severity: (a) without warning signs; (b) with warning signs, such as abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, increasing haematocrit and thrombocytopenia; and (c) severe dengue with severe plasma leakage, severe bleeding or organ failure. Atypical clinical presentations of DF are defined as expanded dengue syndrome: this includes renal, cardiac, hepatic or cerebral damage. We report such a severe case where a young man developed acute kidney injury, acute fulminant liver failure and acute pancreatitis secondary to DF, but recovered.

Managing the Complication of Band Erosion in Banded Sleeve Gastrectomy: A Case Report

We present a case involving a patient with laparoscopic banded sleeve gastrectomy (BSG) with a 3-month history of persistent vomiting, decreased tolerance for fluids, and limited intake of soft food items. Upon investigation, an eroded band and gastric dilatation were identified. The treatment involved the removal of the eroded band and a segment of the stomach, followed by the restoration of gastric continuity through a gastrogastrostomy.

A Case Report on Gastroparesis Secondary to a Posterior Fossa Tumor.

Introduction. Gastroparesis is an uncommon condition with scarce available literature. The presented child had a three-month history of persistent unexplained vomiting and inability to maintain adequate nutrition with severe gastroparesis on gastric emptying study. He was refractory to medical and surgical management. 
 Case Report. A 20-month-old male was brought into the ED and diagnosed with gastroenteritis. Abdominal X-ray was normal, and the vomiting persisted despite antiemetic (ondansetron) administration. He was started on bethanechol for gastroparesis, which was changed to intravenous metoclopramide as he did not tolerate the oral route. His presentation further progressed with intracranial hypertension, hydrocephalus, seizure, and acute respiratory failure necessitating intubation. He was subsequently diagnosed with an atypical teratoid rhabdoid tumor of the cerebellum, for which pediatric neurosurgery performed surgical resection.
 Discussion. The patient was initially diagnosed with post-viral gastroparesis; however, he had shown poor response to medical and surgical therapy and later presented with developmental regression and signs of increased intracranial pressure leading to the diagnosis. In this case, we speculate that the development of gut dysmotility results from disruption of the dorsal motor nucleus of the vagus and autonomic nuclei in the brain stem, which may also have been the reason for medication resistance. 
 Conclusion. Pediatric gastroparesis is largely diagnosed as idiopathic; however, clinicians should be vigilant to look for secondary causes, especially in treatment-resistant cases.

Tuberculosis Meningitis in a 9‐Month‐Old Girl during the COVID‐19 Pandemic

Tuberculous meningitis (TBM) is a serious form of TB disease that can result in high morbidity and mortality, particularly if there are delays in diagnosis and treatment. In this case report, a 9‐month‐old girl was admitted with persistent vomiting and focal seizures. On examination, she was found to have a right‐side hemiparesis. Brain imaging showed intense nodular leptomeningeal enhancement, hydrocephalus, a hypolucent lesion in the left basal ganglia, arterial stenosis and vasculitis, and an old ischemic insult. The patient was initially diagnosed with an acute ischemic stroke and was treated with aspirin and antiepileptic drugs. The patient’s condition failed to improve despite initial treatment, leading to further diagnostic procedures. The results uncovered a diagnosis of TBM. The case highlights the importance of considering TBM as a possible cause of neurological symptoms, especially during the coronavirus disease 2019 (COVID‐19) pandemic where similar symptoms can be present in cases of neurological complications of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and multisystem inflammatory syndrome in children (MIS‐C).

Prevalence of hyperemesis gravidarum and associated factors among pregnant women at comprehensive specialized hospitals in northwest Ethiopia: Multicenter cross-sectional study

Background: Hyperemesis gravidarum is one of the problems encountered among pregnant women due to persistent and excessive vomiting starting before the end of the 22nd week of gestation. The current study aimed to assess the prevalence of hyperemesis gravidarum and associated factors among pregnant women at comprehensive specialized hospitals in northwest Ethiopia. Methods: A multi-facility-based cross-sectional study was conducted at comprehensive specialized hospitals from 1st June 2022 to 30th July 2022. The data were entered using EPI Data Version 4.6 statistical software and analyzed using SPSS Version 26. Descriptive statistics such as frequency, mean, and percentage were calculated. Univariable and multivariable binary logistic regression analyses were carried out to identify the associated factors of hyperemesis gravidarum. Results: In all, 404 study participants were enrolled. About 16.8% of pregnant women were found to have hyperemesis gravidarum. Age < 20 year (AOR = 3.170; 95% CI: 1.119, 8.980), study participants who cannot read and write (AOR = 5.662; 95% CI: 2.036, 15.7470), grade 1–8 (AOR = 4.679; 95% CI: 1.778, 12.316), and grade 9–10 (AOR = 8.594; 95% CI: 3.017, 24.481), being housewife (AOR = 6.275; 95% CI: 1.052, 37.442), living in urban area (AOR = 2.185; 95% CI: 1.035, 4.609), having previous hyperemesis gravidarum (AOR = 2.463; 95% CI: 1.210, 5.012), having family history of hyperemesis gravidarum (AOR = 2.014; 95% CI: 1.002, 4.047), unplanned pregnancy (AOR = 2.934; 95% CI: 1.030, 8.351), having recent abortion (AOR = 2.750; 95% CI: 1.010, 7.483), and gravidity (AOR = 1.956; 95%CI: 1.023, 3.737) were factors associated with hyperemesis gravidarum. Conclusion: The prevalence of hyperemesis gravidarum is higher. Low maternal age, lower educational level, being a housewife, being an urban resident, having previous hyperemesis gravidarum, having a family history, having an unplanned pregnancy, and having a recent abortion were significantly associated with hyperemesis gravidarum.

SHORT AND LONG-TERM RESULTS OF LAPAROSCOPIC ESOPHAGOCARDIOMYOTOMY WITH FUNDOPLICATION (HELLER-PINOTTI SURGERY) IN THE TREATMENT OF NON-ADVANCED ACHALASIA (MEGAESOPHAGUS).

Videolaparoscopic esophagocardiomyotomy with fundoplication has been a widely used technique for the treatment of achalasia. This study analyzes the safety and effectiveness of the technique in the treatment of non-advanced achalasia (megaesophagus) in a Brazilian federal university public hospital. To evaluate the short- and long-term results of videolaparoscopic treatment of non-advanced megaesophagus in a public university hospital in Brazil, employing the esophagocardiomyotomy technique with fundoplication. The medical records of 44 patients who underwent surgical treatment for non-advanced achalasia at the Clinical Hospital of Federal University of Uberlândia (UFU-MG), Minas Gerais, from January 2001 to July 2021 were analyzed. The following data were evaluated: gender, age, etiology, radiological classification of Rezende-Alves and Ferreira-Santos, immediate and late complications (mean follow-up of 31.4 months), need or not for conversion to open access, postoperative reflux, performance or not of endoscopic esophageal dilation in the preoperative period, postoperative mortality, frequency of pre and postoperative symptoms (persistent dysphagia, regurgitation, heartburn, vomiting, odynophagia, and weight loss), surgery time, hospital stay, duration of dysphagia, pre and postoperative weight, and Eckardt score. Among the analyzed patients, 23 (52.3%) were male, and 21 (47.7%) were female, with a mean age of 50.8 years. No early complications were recorded and there were 27.2% cases of late gastroesophageal reflux. Postoperative weight gain was 81.8% and the success rate of surgery according to the Eckardt score was 84.1%. Esophagocardiomyotomy with fundoplication is an effective and safe technique for the treatment of non-advanced achalasia.

Management of cytomegalovirus reactivation in patient with immunotherapy-induced gastritis.

We present the case of a 52-year-old woman diagnosed with stage IV clear cell renal cell carcinoma who received combination of surgery and systemic therapy with nivolumab (anti-PD1) and ipilimumab (anti-CTLA-4). During treatment, patient presented oral intolerance, vomiting and abdominal pain. Computed tomography (CT) and gastroscopy (EGD) were performed, identifying findings suggestive of severe gastro-duodenitis with friability and diffuse oedema of the mucosa and deep ulcers. A gastrointestinal immunotherapy-induced toxicity was suspected so patient was managed with proton pump inhibitors (PPIs) and intravenous corticosteroids 1mg/Kg. Three weeks later, corticosteroid treatment failed. EGD was repeated and gastric biopsies were taken for histological and microbiological tests. Gastric biopsies revealed the presence of cytomegalovirus (CMV) inclusion bodies by immunohistochemistry (IHC). CMV viral load by quantitative PCR in plasma was 2,000 IU/mL so intravenous ganciclovir was prescribed. Then, the patient presented poor clinical course with persistent vomiting due to a failure of first-line corticosteroid and antiviral treatment. Another EGD was performed. Last IHC reveals a low CMV viral load. Second-line treatment with Anti-TNF was performed using a single-dose regimen of intravenous infliximab 5 mg/Kg. Finally, the patient presented a clinical and endoscopic response and a negative CMV DNA test in the blood after completing the antiviral treatment.

Multifaktorska etiologija atipičnog hemolitičko uremijskog sindroma - prikaz slučaja

Abstract: Introduction: Hemolytic uremic syndromes are characterized by the simultaneous occurrence of hemolytic anemia, microangiopathy, thrombocytopenia, and acute renal insufficiency. In terms of the clinical prodrome, they can be classified as typical, which is more common and occurs in 90% of cases, often preceded by diarrheal syndrome induced by enterohemorrhagic Escherichia coli. Alternatively, there is an atypical and rarer form associated with pneumococcal infection, dysregulation of the alternative complement pathway, and cases involving the use of cyclosporine. Hemolytic anemia is confirmed in laboratory analyses (presence of fragmented red blood cells, decreased hemoglobin, undetectable haptoglobin values, and elevated LDH values), along with thrombocytopenia and an increase in nitrogenous substances (urea and creatinine). Case report: The report details the case of an 18-month-old girl who experienced acute renal insufficiency subsequent to a respiratory infection. Ten days preceding admission, the patient exhibited nasal discharge, and during the seven days leading up to hospitalization, she presented with fever. Furthermore, two days prior to admission, the onset of persistent vomiting and abdominal pain occurred. Suspected of bowel intussusception, the patient underwent a surgical assessment where acute surgical pathology was ruled out. The absence of urination, coupled with heightened urea and creatinine levels, prompted consideration of hemolytic-uremic syndrome, later confirmed as atypical during hospitalization. This was grounded in the clinical presentation, devoid of diarrhea syndrome but marked by nasal discharge over the preceding ten days. The administration of fresh frozen plasma yielded no improvement, and there were decreased values of the C3 complement component, H factor, and reduced ADAMTS13 activity. The lack of verotoxins from enterohemorrhagic Escherichia coli further supported the diagnosis of atypical hemolytic-uremic syndrome. After the first dose of eculizumab, a terminal complement C5 component inhibitor, the girl recovered renal function and established diuresis. Conclusion: The prompt diagnosis of atypical hemolytic-uremic syndrome is challenging due to nonspecific symptoms like nasal discharge, vomiting, fatigue, and abdominal pain. Laboratory analyses, lacking specific criteria, make it difficult to conclusively identify aHUS at the disease's onset. In Serbia, pneumococcal immunization is recommended as a preventive measure, administered through a conjugated vaccine in three doses starting from the second month of life. Rapid and accurate differentiation between typical and atypical HUS is crucial for effective treatment and prognosis. Typical HUS requires hemodialysis and plasmapheresis, whereas atypical HUS is managed with plasmapheresis, immunosuppressive therapy, and eculizumab. Administering eculizumab heightens the risk of meningococcal infection by inhibiting the C5 complement component. Therefore, it is crucial not to disregard the importance of meningococcal immunization.