Atypical Haemolytic Uraemic Syndrome Associated with Clostridium difficile Infection Successfully Treated with Eculizumab

Abstract

Clostridium difficile infection is a rare precipitant of atypical haemolytic uraemic syndrome (aHUS). A 46-year-old man presented with watery diarrhoea following an ileocaecal resection. He developed an acute kidney injury with anaemia, thrombocytopaenia, raised lactate dehydrogenase, low haptoglobin, and red cell fragments. Stool sample was positive for C. difficile toxin B. He became dialysis-dependent as his renal function continued to worsen despite treatment with empiric antibiotics and plasma exchange. The ADAMTS13 level was normal consistent with a diagnosis of aHUS. The commencement of eculizumab led to the resolution of haemolysis and stabilisation of haemoglobin and platelets with an improvement in renal function.

Clostridioides difficile-Associated Atypical Hemolytic-Uremic Syndrome Successfully Treated With Eculizumab: A Case Report and Literature Review

“…Finally, our patient had significant neurologic symptoms to include seizures, EEG, and MRI findings as discussed above, leading to mechanical intubation for several days. In previously reported cases, only four other patients had neurologic symptoms, however none as profound as our patients (2–7). This case highlights that the high morbidity and mortality associated with aHUS likely also present with CD-aHUS and that timely recognition and initiation of appropriate therapy are integral to improving outcomes.…”

“…Primary aHUS has been attributed to infections such as Streptococcus pneumoniae, but a possible relationship with Clostridioides difficile infections has also been described. Our literature review demonstrates nine adult patients diagnosed with C. difficile -associated aHUS (CD-aHUS) (2–7), although the exact mechanism is poorly understood (8). Of these cases, only two have been treated effectively with plasmapheresis and eculizumab.…”

Atypical Hemolytic Uremic Syndrome Associated With Clostridium Difficile Infection

“…Our patient responded positively with normalization of hemoglobin, platelet count, LDH, and creatinine levels. The use of eculizumab leads to the resolution of symptoms in patients with C. difficile-associated aHUS [9].…”

“…Triggers for the development of aHUS are more diverse and include drugs, complement regulation deficits, infections, and pregnancy [6]. In the literature, Clostridium difficile infection is described as a rare precipitant of aHUS [7][8][9].…”

Atypical Hemolytic Uremic Syndrome in the Setting of Acute Clostridium difficile Colitis

“…Initiation of dialysis is indicated in patients with symptomatic uremia, severe fluid overload, or electrolyte abnormality that is refractory to medical therapy. Different conventional treatments have been used in C. difficile -associated HUS, including antibiotics, corticosteroids, and plasmapheresis with convenient response [ 14 ]. Eculizumab, a terminal complement inhibitor, has been shown to be effective and safe in atypical HUS, particularly in regards to long-term renal function and thrombotic microangiopathic events, based on a recent large prospective, observational, multicenter study [ 15 ].…”