Hemolytic uremic syndrome (HUS) is a disorder characterized by the presence of the classic triad: microangiopathic hemolytic anemia, thrombocytopenia and acute renal injury. HUS without acute renal failure can be confused with other hematologic diseases. An infantile HUS caused by a Shiga-toxin-producing Escherichia coli (STEC) O145 strain carrying genotype stx2, ehxA, eae subtype β1 is herein reported. The infant did not require dialysis during the acute stage of HUS, evolved favorably, maintained normal blood pressure and normal renal function and had no recurrence until the last control. This could be due to several factors, such as the characteristics of infecting STEC strain and a reduction in host susceptibility to renal injury. This report highlights the regional participation of non-O157 STEC in childhood diseases and the importance of performing active surveillance for all forms of HUS.
A combined therapeutic intervention -pharmacological and psychological-is described for the treatment of a patient previously diagnosed of Bipolar Disorder. The cooperation of psychiatrists and psychologists helped to set an alternative diagnosis (depression) and the subsequent treatment. The therapeutic outcome obtained shows the need to assume, under certain circumstances, several simultaneous and competitive diagnoses, especially when the overall pattern of the gathered data cannot be unequivocally translated into symptoms according to current diagnostic criteria.
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