Late onset of hemolytic uremic syndrome after the appearance of prodromal gastrointestinal tract symptoms

Hirata, Chihiro; Kenzaka, Tsuneaki; Akita, Hozuka

doi:10.1002/ccr3.3020

Cited by 1 publication

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References 19 publications

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“…However, differing from previously reported pathogenesis of TTP, the ADAMTS13 activity was not < 10% [ 8 ]. Moreover, the condition differed from HUS because Shiga toxins were not involved and kidney failure did not occur [ 9 , 10 ]. We believe that ADAMTS13 was markedly reduced in the present case as a result of the presumed mechanism of the stimulation of vascular endothelial cells and promotion of excessive tissue factor and vWF production [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Multiple thrombosis associated with Cytomegalovirus enterocolitis in an immunocompetent patient: a case report

et al. 2021

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Background Cytomegalovirus (CMV) is reported to have thrombogenic characteristics that activate factor X in vitro and stimulate the production of factor VIII and von Willebrand factor (vWF). Thrombosis associated with CMV infection is prevalent among immunocompromised patients and predominantly presents as a solitary large thrombus in the deep vein, pulmonary artery, splanchnic arteriovenous ducts, or other similar sites. Multiple thrombi, however, are rarely observed in such cases. Here, we report about an immunocompetent man with multiple microthrombi associated with CMV infection. Case presentation A 72-year-old Japanese man who complained of abdominal pain was hospitalized with multiple colonic stenosis. He was later diagnosed with CMV enterocolitis and treated with ganciclover from Day 27 post-admission. During hospitalization, the patient developed thrombi in his fingers. He was initially treated with anticoagulant therapy (rivaroxaban); however, the therapy was discontinued owing to a prolonged activated thromboplastin time and an elevated international normalized ratio of prothrombin time. Instead, vitamin K and fresh-frozen plasma were administered. Nevertheless, his coagulation profile remained abnormal. Eventually, he developed colonic perforation and had to undergo emergency surgery. An intraoperative specimen showed several microthrombi in the middle and small arteriovenous ducts of his small and large intestines. The patient’s coagulopathy improved preoperatively, and his overall condition improved postoperatively. Since the activation of ADAMTS13 was reduced remarkably, the thrombotic tendency was determined to be a thrombotic microangiopathy-like condition owing to increased vWF. We could not attribute the coagulopathy to any other cause except CMV infection; therefore, we concluded that this was a case of multiple thrombosis associated with CMV. Conclusions We present an extremely rare case of a patient with multiple thrombotic microangiopathy-like microthrombosis caused by CMV infection. Our findings suggest that CMV infection may be considered as a differential diagnosis for immunocompetent individuals who present with thrombosis of unspecified cause.

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Section: Discussionmentioning

confidence: 99%

Multiple thrombosis associated with Cytomegalovirus enterocolitis in an immunocompetent patient: a case report

et al. 2021

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Late onset of hemolytic uremic syndrome after the appearance of prodromal gastrointestinal tract symptoms

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 1 publication

References 19 publications

Multiple thrombosis associated with Cytomegalovirus enterocolitis in an immunocompetent patient: a case report

Multiple thrombosis associated with Cytomegalovirus enterocolitis in an immunocompetent patient: a case report

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