SHM Converge Scientific Abstract ePoster Gallery-Shiga-Toxin Related Typical Hemolytic Uremic Syndrome Responsive to Eculizumab

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This case report describes a 36-year-old man with Shiga-toxin 2–associated hemolytic uremic syndrome (HUS), a thrombotic microangiopathy characterized by thrombocytopenia, acute kidney injury, and microangiopathic hemolytic anemia. He initially presented with a week of diarrhea that progressed to bloody stools, then developed worsening thrombocytopenia and renal impairment. Stool testing confirmed infection-mediated HUS.<br /><br />He was first treated with supportive care, which improved his platelet count and kidney function. However, his condition then worsened neurologically, with dizziness, blurred vision, encephalopathy, and seizures requiring intubation and antiepileptic therapy. Brain MRI showed bilateral thalamic and inferior colliculi infarcts. Lumbar puncture was unrevealing.<br /><br />A 3-day course of plasma exchange did not significantly improve his neurologic status. Because seizures persisted despite escalating antiepileptic medications, eculizumab was administered. After treatment, his neurologic function improved and seizures were controlled. He eventually returned to baseline, received a second dose of eculizumab, and was discharged without further plasma exchange or additional doses.<br /><br />The authors note that supportive care remains standard treatment for typical infection-mediated HUS, while eculizumab is usually reserved for complement-mediated HUS. This case suggests that some patients with Shiga-toxin HUS may have clinically meaningful complement activation and may benefit from eculizumab, especially when severe neurologic involvement is present.

Asset Subtitle

Bryan Hoang

Meta Tag

Author List Bryan Hoang, Subhan Tabba, Tapan Patel

Category Clinical Vignettes

Concept Hemolytic Uremic Syndrome

Concept Thrombotic Microangiopathy

Concept Shiga Toxin

Concept Infection-Mediated HUS

Concept Complement-Mediated Hemolytic Uremic Syndrome

Distinguished Non-Finalist

Presenter Organization Texas Health Presbyterian

Presenting Author Bryan Hoang

Track Adult

Keywords

Shiga-toxin 2

hemolytic uremic syndrome

HUS

thrombotic microangiopathy

thrombocytopenia

acute kidney injury

microangiopathic hemolytic anemia

eculizumab

neurologic complications

plasma exchange

Hemolytic Uremic Syndrome

Thrombotic Microangiopathy

Shiga Toxin

Infection-Mediated HUS

Complement-Mediated Hemolytic Uremic Syndrome