An Atypical Case of Shiga Toxin Producing-Escherichia Coli Hemolytic and Uremic Syndrome (STEC-HUS) in a Lung Transplant Recipient

Abstract

We herein describe the first case of thrombotic microangiopathy (TMA) which was related to Shiga toxin producing-Escherichia Coli Hemolytic and Uremic Syndrome (STEC-HUS) after lung transplantation. His maintenance immunosuppression relied on tacrolimus plus mycophenolic acid. TMA was treated with plasma exchanges (PE) (fresh frozen plasma substitution). After five days of PE, platelets count and lactate dehydrogenase level normalized, whereas hemoglobin continued to gradually decrease and no improvement in kidney function was observed. After seven PE sessions, all TMA biological signs resolved. However, kidney function did not improve, and the patient still required chronic dialysis.

Shiga Toxin–Associated Hemolytic Uremic Syndrome in Adults, France, 2009–2017

“…The risk for death from STEC-associated HUS increases for persons age >40 years, suggesting that young and middle-aged adults have similar clinical courses to those observed in children. We found a strong association between underlying conditions and decreased survival, especially for patients with immunodeficiency (9,(20)(21)(22)(23). The prevalence of antibodies against Stx decreases for persons >40 years of age (24), which might account for the more severe forms of STEC-associated HUS in elderly persons.…”

Hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli in a renal transplant recipient case report

“…In relation to post-transplant STEC-HUS, a case has been described in a patient with lung transplant who had a serious neurological compromise in response to management with plasma exchange 11 . Another report describes a patient with a bone marrow transplant who presented neurological symptoms and deterioration of renal function, and who received management with eculizumab with improvement of neurological symptoms, as well as stabilization of renal function at 7 months of follow-up 4 .…”

“…In children, it is based on support management, with dialysis, transfusions, and antihypertensive drugs, and in adults, in addition to the above, some authors propose plasma exchange, others, eculizumab, without solid evidence in favor of one or another therapy 7 - 10 . In relation to post-transplant STEC-HUS, a case has been described in a patient with lung transplant who had a serious neurological compromise in response to management with plasma exchange 11 . Another report describes a patient with a bone marrow transplant who presented neurological symptoms and deterioration of renal function, and who received management with eculizumab with improvement of neurological symptoms, as well as stabilization of renal function at 7 months of follow-up 4 .…”