[Hemolytic uremic syndrome following EHEC infection]

We report on four patients treated for typical hemolytic uremic syndrome (HUS) at our hospital during the outbreak in Germany in May 2011. Three out of four patients had previously travelled to northern Germany, one patient was exposed within the family.

All patients were tested positive for enterohemorrhagic E.coli of the type O104:H4 in stool cultures and presented with signs of thrombotic microangiopathy and fragmented erythrocytes.

Due to strong hemolytic activity (LDH >600 U/l), thrombocytopenia (< 60,000/µl) und acute kidney injury (creatinine >1.2 mg/dl) plasma separation with fresh frozen plasma was commenced in three out of four patients with the fourth patient exhibiting a self-limiting course. Altogether, it took 7 to 13 treatments until disease activity was stopped. During treatment, kidney injury recovered and all patients had negative stool cultures.

The HUS-outbreak 2011 in Germany was associated with a severe course in many patients, particularly in women. Treatment with plasma separation was successful to stop hemolysis and end disease activity.