Management of streptococcal pneumoniaeinduced hemolytic uremic syndrome: a case report

Abstract

Hemolytic uremic syndrome (HUS) secondary to Streptococcus pneumoniae infections (pHUS) has been well reported in the literature and accounts for roughly 5% of all the cases of HUS. However, this condition is likely under-diagnosed and the incidence is believed to be increasing. Given this increase in incidence of pHUS, it is important to have an understanding of the optimal means to manage the disease. We report a case of a 2-year-old male with pneumonia, acute kidney injury (AKI), microangiopathic hemolytic anemia (MAHA), and thrombocytopenia, diagnosed with pHUS and successfully treated with antibiotics, washed red blood cell (RBC) transfusions, plasma exchange (PE) with 5% albumin replacement, steroids, and hemodialysis. The response seen in our patient adds to the current literature and further supports the use of PE with albumin in patients with pHUS.

Complete Renal Recovery in Pediatric Patient with Streptococcus pneumoniae-Associated HUS: A Case Report and Literature Review

“…In the literature there are two case reports which demonstrated successful use of plasmapheresis in the context of Sp-HUS. [21,22] Our case provides further evidence in favor of the use of plasmapheresis in Sp-HUS, as our patient received a total of 9 treatments with subsequent significant improvement in her thrombocytopenia (Figure 2). Eculizumab is a C5 inhibitor, and it is a humanized monoclonal IgG that binds to and blocks the cleavage of the C5 complement protein, thereby disrupting Volume 08; Issue 06 J Urol Ren Dis, an open access journal ISSN: 2575-7903 the formation of the membrane attack complex.…”

Virginia Henderson’s Writings on the Nature of Nursing: An Exemplar of Nursing Practice

“…The highest prevalence of this disease has been reported in children under 5 years of age (Walsh & Johnson, 2018). HUS can have many causes; typical HUS is most often associated with strains of Escherichia coli causing an intestinal infection and diarrhea or a respiratory infection usually caused by Streptococcus pneumonia (Weintraub et al, 2014). Occasionally, HUS is associated with exposure to certain medications or abnormalities in part of the immune system called the complement system (Ylinen et al, 2020).…”

Streptococcus Pneumoniae-Associated Hemolytic Uremic Syndrome in the Era of Pneumococcal Vaccine

“…Clinical studies have also focused on treatment of the pathophysiologic process of Sp-HUS disease. An attempt has been made to remove or reduce the levels of anti-T antigen antibodies and neuraminidase in Sp-HUS patients with the use of plasmapheresis/plasma exchange (PE) [33,[107][108][109]. In a case series, PE was used to treat Sp-HUS disease in 6 of 43 (16%) patients [33].…”

“…All six Sp-HUS patients who received PE survived [33]. Likewise, isolated case reports of Sp-HUS patients have reported good outcomes of severe Sp-HUS children after PE administration [107][108][109]. However, there has been a concern for using this modality of treatment, as donor plasma demonstrates the presence of anti-T IgM class antibodies that may interact with T antigen, in Sp-HUS patients, and worsen the pre-existing hemolysis [110].…”