Haemolytic-uraemic syndrome with thrombotic microangiopathy of the retina following cytomegalovirus infection: postmortem findings

Catón, B.; Otazu, R. Díaz de; Aldamiz-Echebarria, M.; Viguri, Amparo

doi:10.1136/pgmj.69.814.653

Cited by 17 publications

(9 citation statements)

References 12 publications

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“…Neau et al (13) reported a 30‐year‐old female with primary CMV infection complicated by microangiopathic hemolytic anemia and neurologic symptoms, but without renal failure, who responded to high‐dose corticosteroids, blood plasma transfusions, and foscarnet. Caton et al (14) described a 37‐year‐old female with acute CMV infection, microangiopathic hemolytic anemia, acute renal failure, and severe encephalopathy. The patient was treated with corticosteroids, but ultimately died of consequences of hypoxic‐ischemic encephalopathy.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic microangiopathy and cytomegalovirus in liver transplant recipients: a case‐based review

Ramasubbu

Mullick

Koo

et al. 2003

Transplant Infectious Dis

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Section: Discussionmentioning

confidence: 99%

Thrombotic microangiopathy and cytomegalovirus in liver transplant recipients: a case‐based review

Ramasubbu

Mullick

Koo

et al. 2003

Transplant Infectious Dis

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“…It is unlikely that changes in anti-retroviral therapy triggered the onset of HUS.16 Severe hypertension was an early prominent sign in four cases, although the retinal features observed in two individuals were probably secondary to retinal vascular microangiopathy as they failed to resolve despite adequate antihypertensive therapy. 17 All patients received standard treatment for anaemia (blood transfusions) and required haemodialysis for renal support. Measures to limit vascular injury such as fresh frozen plasma and prostacyclin failed to arrest disease progression although the efficacy of these treatments remains to be determined.6 Unlike D+ HUS where glomerular thrombosis is the main pathology, intravascular thromboses involving arterioles and small arteries were noted and acute tubular necrosis reflecting extensive vascular occlusion was seen in three of the four cases examined.…”

Section: Discussionmentioning

confidence: 99%

The haemolytic uraemic syndrome in patients with AIDS.

Kelleher

Severn

Tomson

et al. 1996

Sexually Transmitted Infections

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Objective: Thrombotic microangiopathies have been increasingly recognised in HIV infection. The contribution of haemolytic uraemic syndrome (HUS) has not received as much emphasis as other members of the thrombotic microangiopathies. We describe the clinical features and prognosis of HUS in a group of patients with AIDS. Setting: St Bartholomew's and The Middlesex Hospitals, London. Patients: Five HIV seropositive individuals with clinical and histological features consistent with HUS.Interventions: Blood transfusion, fresh frozen plasma, haemodialysis, renal biopsy, autopsy. Conclusions: HUS occurs in advanced HIV infection. Hypertension was a prominent clinical feature in HUS in this patient group. Measures to limit renovascular damage were unsuccessful and haemodialysis was usually needed to support renal function. The prognosis is poor, no patient achieved clinical remission and all died.

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“…For some infections, the pathogenesis of microangiopathic hemolytic anemia has been described. Examples are bacterial endocarditis, [62] bacterial infections associated with microvascular injury such as brucellosis [32,33] streptococcal infections resulting in acute glomerulonephritis, [66] angioinvasive fungi such as aspergillosis, [83], and viruses and rickettsiae that cause endothelial injury such as CMV, [71][72][73] HIV, [16] erlichiosis, [44] and Rocky Mountain spotted fever [56]. However for other infections the mechanisms of microangiopathic hemolytic anemia are unclear.…”

Section: Discussionmentioning

confidence: 99%

Systemic infections mimicking thrombotic thrombocytopenic purpura

et al. 2011

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The absence of specific diagnostic criteria, the urgency to begin plasma exchange treatment, and the risk for complications from plasma exchange make the initial evaluation of patients with suspected thrombotic thrombocytopenic purpura (TTP) difficult. Systemic infections may mimic the presenting clinical features of TTP. In the Oklahoma TTP-HUS (hemolytic-uremic syndrome) Registry, 1989–2010, 415 consecutive patients have been clinically diagnosed with their first episode of TTP; in 31 (7%) the presenting clinical features were subsequently attributed to a systemic infection. All 31 patients had diagnostic criteria for TTP; 16 (52%) had the complete “pentad” of microangiopathic hemolytic anemia, thrombocytopenia, neurologic abnormalities, renal failure and fever. Four (16%) of 25 patients who had ADAMTS13 measurements had <10% activity; three patients had a demonstrable ADAMTS13 inhibitor. Compared to 62 patients with severe ADAMTS13 deficiency (<10%) who had no recognized alternative disorders, patients with systemic infections had more frequent fever, coma, renal failure, and the complete “pentad” of clinical features. Seventeen different infectious etiologies were documented. A systematic literature review identified 67 additional patients with a diagnosis of TTP or HUS and also a systemic infection. Among all 98 patients, infections with 41 different bacteria, viruses, and fungi were documented, suggesting that many different systemic infections may mimic the presenting clinical features of TTP. Initial plasma exchange treatment is appropriate in critically ill patients with diagnostic features of TTP, even if a systemic infection is suspected. Continuing evaluation to document a systemic infection is essential to determine the appropriateness of continued plasma exchange.

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Haemolytic-uraemic syndrome with thrombotic microangiopathy of the retina following cytomegalovirus infection: postmortem findings

Cited by 17 publications

References 12 publications

Thrombotic microangiopathy and cytomegalovirus in liver transplant recipients: a case‐based review

Thrombotic microangiopathy and cytomegalovirus in liver transplant recipients: a case‐based review

The haemolytic uraemic syndrome in patients with AIDS.

Systemic infections mimicking thrombotic thrombocytopenic purpura

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