<i>Streptococcus pneumoniae</i>-Associated Hemolytic Uremic Syndrome in a Splenectomized Adult Patient

Abstract

A 62-year-old splenectomized woman was admitted because of upper respiratory tract symptoms, general fatigue, and purpura. Laboratory data demonstrated microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure, and a positive Streptococcus pneumoniae (SP) urinary antigen test. A renal biopsy showed thrombotic microangiopathic changes. She was diagnosed with hemolytic uremic syndrome (HUS) secondary to SP infection. Methylprednisolone pulse therapy in addition to antibiotic therapy led to prompt improvement of her symptoms and laboratory abnormalities. This is the first adult case of SP-associated HUS successfully treated without hemodialysis. SP infection should be considered as a causative etiology in all splenectomized patients with HUS.

Streptococcus pneumoniae-associated thrombotic microangiopathy in an immunosuppressed adult

“…Although pneumococcal disease is common in both children and adults, pTMA usually occurs in children [5,6]. There is a possibility that splenectomy and immunosuppression are associated with pTMA in adults [6]. Our patient was immunosuppressed with prednisolone and methotrexate, and there is a possibility that immunosuppression caused pTMA.…”

“…Invasive pneumococcal disease is defined as severe pneumococcal disease causing meningitis, bacteremia, sepsis or thoracic empyema. Although pneumococcal disease is common in both children and adults, pTMA usually occurs in children [5,6]. There is a possibility that splenectomy and immunosuppression are associated with pTMA in adults [6].…”

“…In addition, the effect of PE in adult pTMA cases is uncertain. Maki et al [6] reviewed five adult pTMA cases in the literature [6,[10][11][12][13]. We summarize the clinical features of the 10 reported cases and the present case in Table 3.…”

Streptococcus Pneumoniae Bacteremia with Acute Kidney Injury and Transient ADAMTS13 Deficiency

“…It is exceptional in adults. But a history of splenectomy can be a possible risk factor [ 3 – 5 ]. The determination of ADAMTS13 activity in plasma could be helpful to specify the type of TMA as ADAMTS13 activity is typically <10% in thrombotic thrombocytopenic purpura (TTP), in contrast to HUS or aHUS.…”