SHM Converge Scientific Abstract ePoster Gallery-An Atypical Presentation of Typical Hemolytic Uremic Syndrome

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This case describes a 38-year-old woman with gastroparesis and PCOS who presented with bloody diarrhea, left lower quadrant pain, nausea, and anorexia. Initial CT imaging showed colitis, and she was discharged from an outside emergency department on antibiotics after stool studies were collected. When her symptoms worsened, she returned to another hospital, where repeat imaging again showed severe colitis. Her initial labs were notable for marked leukocytosis but normal hemoglobin, platelets, and creatinine. Shortly afterward, the outside stool culture returned positive for Escherichia coli O157:H7.<br /><br />During hospitalization, her condition progressed rapidly: she developed acute kidney injury, hemolytic anemia, thrombocytopenia, and neurologic symptoms including hallucinations and myoclonus. A normal ADAMTS13 level argued against thrombotic thrombocytopenic purpura and supported hemolytic uremic syndrome (HUS). She required dialysis, and because of worsening neurologic involvement and an elevated soluble C5b-9 level suggesting complement activation, she was treated with eculizumab. Her hemolysis improved quickly, but neurologic recovery was slow and renal failure persisted, leaving her dialysis-dependent at discharge. Genetic testing for atypical HUS was negative.<br /><br />The report emphasizes that bloody diarrhea should prompt evaluation for infectious causes, including stool cultures, and that antibiotics should generally be avoided initially when Shiga toxin-producing E. coli is suspected because they may increase HUS risk. Typical HUS is caused by Shiga toxin-mediated endothelial injury and is usually treated supportively, whereas atypical HUS is complement-mediated and may respond to eculizumab. This case was unusual because typical HUS occurred in an adult and was unusually severe, with prolonged neurologic and renal complications.

Asset Subtitle

Katherine Oakden

Meta Tag

Author List Katherine Oakden, Michele Fang

Category Clinical Vignettes

Concept Shiga Toxin-Producing Organisms

Concept Hemolytic Uremic Syndrome

Concept Escherichia coli O157H7

Concept Hemolytic Anemia

Concept Thrombocytopenia

Distinguished Non-Finalist

Presenter Organization University of Pennsylvania

Presenting Author Katherine Oakden

Track Adult

Keywords

hemolytic uremic syndrome

Escherichia coli O157:H7

bloody diarrhea

acute kidney injury

thrombocytopenia

hemolytic anemia

eculizumab

Shiga toxin

colitis

dialysis

Shiga Toxin-Producing Organisms

Hemolytic Uremic Syndrome

Escherichia coli O157H7

Hemolytic Anemia

Thrombocytopenia