A 12-year-old boy was transferred to our pediatric department from a rural hospital for fever, cough, and vomiting associated with thrombocytopenia, non-immune hemolytic anemia, and acute kidney injury, leading to the diagnosis of hemolytic uremic syndrome (HUS). A nasopharyngeal swab and a lower respiratory sample detected Influenza A by polymerase chain reaction (PCR). The patient was treated with oseltamivir and intravenous fluids in addition to fresh frozen plasma (FFP). Enteropathogenic Escherichia coli (EPEC) was detected in a stool sample by PCR. Serum antibodies for Mycoplasma pneumoniae (IgM and IgG) and Helicobacter pylori (IgA and IgG) were increased. Further work-up revealed elevated serum C5b-9 suggesting a simultaneous viral and bacterial infection-mediated complement overactivation leading to the diagnosis of atypical HUS (aHUS). An association between aHUS and influenza A is reported in the literature, but the correlation of EPEC, Mycoplasma pneumoniae , and Helicobacter pylori with aHUS is not well-established. Fresh frozen plasma was administered for a total of 3 days, followed by clinical and laboratory improvement. The patient has remained asymptomatic until the latest follow-up, 5 months after discharge. This case demonstrates the potential triggering role of different pathogens in aHUS pathogenesis to raise awareness in the pediatric community.
Competing Interests: None to be declared. Table 1.Laboratory investigations during hospitalization. LabsAdmission and initiation of treatment with FFP (day 4)Day after treatment with FFP (day 7)The day before the discharge (day 13)First follow-up (day 20)Second follow-up (day 50)WBC (103/μL)5.634.997.485.965.08Hb (g/dL)10.69.210.610.813.7PLT (103/μL)12150515404316Schistocytes (%)4.6////Cr (mg/dL)1.91.010.710.580.56Urea (mg/dL)13554382321LDH (U/L)1,765638134197154Total bilirubin (mg/dL)2.81.470.61/0.67Cr = creatinine; Hb = hemoglobin; FFP = fresh frozen plasma; LDH = lactate dehydrogenase; PLT = platelets; WBC = white blood cells.
(© Dustri-Verlag Dr. K. Feistle.)