SHM Converge Scientific Abstract ePoster Gallery-Severe Neurologic Complications of Shiga Toxin-Associated Hemolytic-Uremic Syndrome

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This case describes a 37-year-old previously healthy woman who developed nausea, vomiting, abdominal cramping, and brief “chocolate-colored” diarrhea after eating beef chili. Three days later she presented with persistent gastrointestinal symptoms, fatigue, and lethargy. She was found to have anemia, thrombocytopenia, hemolysis (low haptoglobin, elevated LDH, schistocytes), and severe acute kidney injury, consistent with thrombotic microangiopathy.<br /><br />Because she developed striking neurologic symptoms, including psychomotor slowing, hypophonia, myoclonus, coma, gaze deviation, facial droop, and hyperreflexia, the initial concern was thrombotic thrombocytopenic purpura (TTP). She was therefore started on apheresis on hospital day 1 and eculizumab on day 2 while diagnostic tests were pending. EEG showed severe encephalopathy, MRI of the brain was unremarkable, and her neurologic status did not improve with lorazepam, levetiracetam, or hemodialysis.<br /><br />Definitive testing eventually showed normal ADAMTS13 activity and stool PCR positive for a Shiga toxin-producing organism, confirming Shiga toxin-associated hemolytic-uremic syndrome (ST-HUS). The report emphasizes that ST-HUS is increasingly important to consider in adults with recent diarrheal illness and thrombotic microangiopathy, especially because newer strains can cause severe neurologic complications that mimic TTP. Neurologic manifestations may include dysphasia, hyperreflexia, seizures, and coma, and they may not correlate with renal injury or MRI findings.<br /><br />The key clinical message is that adult patients with diarrheal prodrome, hemolysis, thrombocytopenia, renal failure, and neurologic involvement should be evaluated for ST-HUS, with initial empiric treatment often overlapping with TTP management until ADAMTS13 and stool PCR results clarify the diagnosis.

Asset Subtitle

Rahul Mehta

Meta Tag

Author List Emily Jezewski, Katirina Guinto, Laura Gerrick, Rahul Mehta

Category Clinical Vignettes

Concept Shiga Toxin-Associated Hemolytic-Uremic Syndrome

Concept Thrombocytopenia

Concept Hemolytic Anemia

Concept Acute Kidney Injury

Concept Thrombotic Thrombocytopenic Purpura

Distinguished Non-Finalist

Presenter Organization University of Virginia

Presenting Author Rahul Mehta

Track Adult

Keywords

Shiga toxin-associated hemolytic-uremic syndrome

ST-HUS

thrombotic microangiopathy

thrombocytopenia

hemolysis

acute kidney injury

neurologic complications

TTP differential diagnosis

ADAMTS13 activity

stool PCR

Shiga Toxin-Associated Hemolytic-Uremic Syndrome

Thrombocytopenia

Hemolytic Anemia

Acute Kidney Injury

Thrombotic Thrombocytopenic Purpura