Sudden Cardiac Arrest and Malignant Ventricular Tachycardia in an 8-Year-Old Pediatric Patient Who Has Hemolytic Uremic Syndrome Associated with Shiga Toxin-Producing Escherichia coli

Abstract

Gastrointestinal, neurological, pancreatic, hepatic, and cardiac dysfunction are extrarenal manifestations of hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC-HUS). The most frequent cause of death for STEC-HUS is related to the central nervous system and cardiovascular system. Cardiac-origin deaths are predominantly related to thrombotic microangiopathy-induced ischemia and the immediate development of circulatory collapse. STEC-HUS cardiac related deaths in children are rare with only sporadic cases reported. In our literature search, we did not come across any pediatric case report about STEC-HUS causing sudden cardiac arrest and malignant ventricular tachycardia (VT). Herein, we report the case of an 8-year-old female with a typical clinical manifestation of STEC-HUS. On the seventh day of pediatric intensive care unit admission, the patient had a sudden cardiac arrest, requiring resuscitation for 10 minutes. The patient had return of spontaneous circulation with severe monomorphic pulsed malignant VT. Intravenous treatment with lidocaine, amiodarone and magnesium sulfate were promptly initiated, and we administered multiple synchronized cardioversions, but VT persisted. Furthermore, we were not able to ameliorate her refractory circulation insufficiency by advanced cardiopulmonary resuscitation. Thus, inevitably, the patient lost her life. This case illustrates the need for aggressive management and the dilemma that pediatric critical care specialists, cardiologists, and nephrologists have to face when dealing with STEC-HUS that is worsened by a sudden cardiac arrest accompanied with VT.

Autonomic activity and cardiovascular system risk assessment in pediatric patients with hemolytic uremic syndrome

“…Arrhythmias and related effects are less common in HUS [ 4 ]. In some case reports, ventricular tachycardia and, although rare, sudden cardiac death have been reported [ 16 ]. Predicting which of the patients diagnosed with HUS may be at risk of cardiac arrhythmia will guide physicians about treatment management during the follow-up.…”

Extracorporeal Membrane Oxygenation and Hemolytic Uremic Syndrome in Children: Outcome Review of a Multicenter National Database

“…Prior literature has suggested that among cardiac manifestations, myocardial dysfunction, TMA in cardiac vasculature, and pericardial effusion leading to pericardial tamponade were the most commonly proposed mechanisms leading to ECMO requirement in these patients. [1][2][3]6,13,14 We found that similar manifestations were more likely to result in the requirement for ECMO in critically ill children with HUS. Early recognition by myocardial enzyme estimation and timely echocardiography may help the clinical team determine the level of cardiac involvement to then help reverse clinical outcomes.…”