Postpartum haemolytic uraemic syndrome precipitated by antibiotics. Case report

Abstract

Case reportspecific cultures for Clostridium dificile were A 21-year-old negroid woman booked for her third pregnancy at 28 weeks gestation. Pregnancy was uncventful until 38 weeks whcn she complained of a non-offensive vaginal discharge. A vaginal swab was taken, from which a P-haemolytic streptococcus was cultured. Six days later she was admitted in spontaneous labour and subsequcntly had an uncomplicatcd delivery of a 3 Kg infant. Within 24 h of delivery the patient became pyrexial with a temperature of 38°C. There were no adverse symptoms or physical signs to indicate a source of infection, but a repeat vaginal swab again showed /3-haemolytic streptococcus. 4 coursc of ampicillin (500 mg four times daily) and mctronidazole (400 mg three times daily) was given. The pyrexia settled within 2 4 h and she was discharged on the fourth day postpartum. Blood pressure on discharge was 120170 mmHg. Nine days after delivery she was admitted again complaining of colicky abdominal pain and bloody diarrhoea. O n examination she was pyrexial(38 "C), with a pulse rate of ll21min and a blood pressure of 115190 mmHg. There was no abdominal tenderness, but a profuse mucoid bloody diarrhoea was observed. Intravenous fluids and a course of intravenous metronidazole and ccfuroximc wcrc started. Initial haematological and biochcmical indices were normal ( Fig. 1) with a haemoglobin of 13.0 g/dl, white cell count of 12.8 X 109/1, serum creatinine of 60 and serum urea of 3.6mmol/l. Blood cultures and cultures of stools grew no pathogens, and Registrar in Obstelrics and Gynaecology, The Horton General Hospital, Oxford Road, Banbury, Oxfordshire. Senior Lecturer in Obstetrics and Gynaecology, Birmingham University. K. S . OLnII H. GEE.

The United States National Prospective Hemolytic Uremic Syndrome Study: Microbiologic, Serologic, Clinical, and Epidemiologic Findings

“…Four of the 5 women of childbearing age in the study were pregnant or postpartum; identification of STEC infection in all 3 women who were postpartum suggests that STEC may be an important cause of postpartum HUS. To our knowledge, a clear link beat EKU Libraries,SerialsEastern Kentucky University on November 26, 2014 http://jid.oxfordjournals.org/ Downloaded from tween STEC and postpartum HUS has not been previously made and has not been discussed in reviews of postpartum HUS, although STEC O6:H12 was isolated from the stool of 1 case who did not have gastrointestinal symptoms [32], and bloody diarrhea preceded HUS in another case report [33]. Adults were more likely to meet the criteria for TTP than were children, and all patients who died of TTP were adults.…”

“…Cases were reported most frequently in the summer (figure 1). Patients were from 16 states representing all 4 US census regions: Northeast (4 patients), South (16), Midwest (30), and West (33). The median age of the patients was 4 years (range, 3 months to 64 years).…”

Persistant pre-eclampsia post partum with elevated liver enzymes and hemolytic uremic syndrome

“…This study suggested that healthy women at delivery who have a platelet count of 80 to 150K require no specific treatment and the mode of delivery should be determined only by obstetric indications. Another case of post partum HUS on dialysis recovered following treatment with prostacyclin, fresh frozen plasma (FFP), and cryoprecipitate [50].…”

Postpartum haemolytic uraemic syndrome treated with plasma intusion

“…It presents with the classic triad of acute renal failure, haemolytic anaemia and thrombocytopaenia within a time period of a few days to 10 weeks, as described by Robson et al (1968). Since then cases have been reported in ectopic pregnancy and during the first two trimesters of pregnancy (Olah & Gee 1990). It usually occurs in primigravida but has also been reported in multiparous patients (Li et al 1988).…”

“…The primary defect is a platelet aggregating factor which causes deposition of microthrombi in the vessel wall, microangiopathic haemolytic anaemia and thrombotic occlusions in the microvasculature of the kidney resulting in acute renal failure. In haemolytic uraemic syndrome the pro‐aggregatory factor is thought to be an infectious agent, most commonly the verotoxin producing E. coli 0157:H7 (Olah & Gee 1990). However, in postpartum haemolytic uraemic syndrome it is suggested there is an additional oestrogen effect which is supported by the association with the oral contraceptive pill (Olah & Gee 1990).…”