Alternative treatment for systemic involvement in a child with postdiarrheal hemolytic-uremic syndrome

E, Oki; Tsuruga, Kazushi; Tsugawa, Koji; Suzuki, Kazutoshi; Shinagawa, Tomoe; Nakahata, Tohru; Ito, Eiji; Tanaka, Hiroshi

doi:10.5414/cnp70354

Cited by 5 publications

(7 citation statements)

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“…mPSL pulse therapy should be considered for patients with severe symptoms; however, the efficacy of mPSL pulse therapy for HUS encephalopathy has not yet been established. We investigated the cases in which HUS encephalopathy was treated with mPSL pulse therapy ( Table ) ( 7 , 19 - 23 ). The number of days from the onset of HUS to encephalopathy and mPSL pulse therapy varied.…”

Section: Discussionmentioning

confidence: 99%

Hemolytic Uremic Syndrome-associated Encephalopathy Successfully Treated with Corticosteroids

2017

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The encephalopathy that occurs in association with hemolytic uremic syndrome (HUS), which is caused by enterohemorrhagic Escherichia coli (E. coli), has a high mortality rate and patients sometimes present sequelae. We herein describe the case of a 20-year-old woman who developed encephalopathy during the convalescent stage of HUS caused by E. coli O26. Hyperintense lesions were detected in the pons, basal ganglia, and cortex on diffusion-weighted brain MRI. From the onset of HUS encephalopathy, we treated the patient with methylprednisolone (mPSL) pulse therapy alone. Her condition improved, and she did not present sequelae. Our study shows that corticosteroids appear to be effective for the treatment of some patients with HUS encephalopathy.

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Section: Discussionmentioning

confidence: 99%

Hemolytic Uremic Syndrome-associated Encephalopathy Successfully Treated with Corticosteroids

2017

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“…In the present case, marked leukocytosis associated with serum CRP elevation was noted. Based on our previous clinical experience, systemic inflammatory conditions possibly due to pro‐inflammatory hypercytokinemia may play an important role in the pathogenesis of serious complications of HUS . Thus, a prolonged systemic inflammatory condition may have caused the new‐onset microangiopathy and ischemic colitis in the left colon in the present patient, although this remains speculative.…”

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confidence: 83%

“…Because of oliguria associated with a possible systemic inflammatory state, continuous hemodiafiltration (CHDF) under nafamostat mesilate and i.v. high‐dose immunoglobulin (1 g/kg per day for 3 consecutive days) were initiated . Given that the AKI and the other HUS signs gradually improved within 2 weeks, CHDF was stopped on hospital day 15.…”

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confidence: 99%

Post‐acute ischemic change and colon stricture in hemolytic uremic syndrome

Kobayashi

Watanabe

Tsuruga

et al. 2017

Pediatrics International

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“…The toxicity of A. phalloides is related to amatoxin which inhibits RNA polymerase II within enterocytes, hepatocytes and proximal renal tubular cells. 2 A progressive liver injury…”

Section: End-stage Kidney Disease After Mushroom Poisoning and Abo-inmentioning

confidence: 99%

“…1). Because residual pro‐inflammatory hypercytokinaemia was strongly suspected, anti‐pro‐inflammatory cytokine therapy consisting of MPT (25 mg/kg daily for 3 consecutive days, two sessions) and IVIG (1 g/kg per day, twice) was initiated 2 . Following this therapy, her clinical condition significantly improved.…”

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confidence: 99%

Anti‐inflammatory Treatment for Post‐diarrhoeal Haemolytic–uraemic Syndrome With Central Nervous System Involvement

et al. 2010

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It has been reported that systemic release of proinflammatory cytokines may be responsible for the coordination of acute inflammatory processes in some children with haemolytic-uremic syndrome (HUS). 1 We encountered the case of a Japanese girl with post-diarrhoeal HUS who subsequently fell into a convulsive state and prolonged unconsciousness caused by HUS encephalopathy. Because pre-existing pro-inflammatory hypercytokinaemia was probably involved in her clinical condition, anti-inflammatory treatment with methylprednisolone pulse therapy (MPT) and high-dose i.v. immunoglobulin (IVIG) was initiated. The treatment proved effective and the patient recovered with no sequelae.A 5 year old girl was taken to a regional hospital with a 3 day history of fever, diarrhoea and colicky abdominal pain.The stool culture and latex aggregation test for Vero toxin 2 were positive, indicating recent enterohaemorrhagic Escherichia coli infection. Because the child presented oliguria, haemodialysis was promptly initiated. The patient had mild disturbance of consciousness (Glasgow Coma Scale 4-4-6). Laboratory studies revealed typical HUS manifestations and markedly increased levels of plasma ferritin and serum soluble interleukin-2 receptor. Three days later, she developed generalized tonic seizures. Magnetic resonance imaging (MRI) performed on hospital day 12 showed areas of high intensity on fluid attenuated inversion recovery (FLAIR) images in the left putamen and the cerebellar vermis, which were compatible with the diagnosis of HUS encephalopathy (Fig. 1). Because residual pro-inflammatory hypercytokinaemia was strongly suspected, anti-pro-inflammatory cytokine therapy consisting of MPT (25 mg/kg daily for 3 consecutive days, two sessions) and IVIG (1 g/kg per day, twice) was initiated. 2 Following this therapy, her clinical condition significantly improved. Interestingly, we observed a dramatic and rapid improvement of her level of consciousness after IVIG. The follow-up MRI performed on hospital day 30 showed the areas of high signal intensity had completely disappeared. These favourable MRI changes suggested that her encephalopathy had mimicked posterior reversible encephalopathy syndrome 3 which could be A B Fig. 1 Magnetic resonance imaging performed on hospital day 12 showed areas of high intensity on FLAIR images in the left putamen (A) and the cerebellar vermis (B).Nephrology 15 (2010) 659-662

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Alternative treatment for systemic involvement in a child with postdiarrheal hemolytic-uremic syndrome

Cited by 5 publications

References 0 publications

Hemolytic Uremic Syndrome-associated Encephalopathy Successfully Treated with Corticosteroids

Hemolytic Uremic Syndrome-associated Encephalopathy Successfully Treated with Corticosteroids

Post‐acute ischemic change and colon stricture in hemolytic uremic syndrome

Anti‐inflammatory Treatment for Post‐diarrhoeal Haemolytic–uraemic Syndrome With Central Nervous System Involvement

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