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Severe pneumococcal hemolytic uremic syndrome in an 8-month-old girl
Tahar Gargah1, Majda Cherif, Rim Goucha-Louzir
1Department of Pediatric Nephrology, Charles Nicolle Hospital, Tunis, Tunisia. kitomora@yahoo.fr
Insights
Streptococcus pneumoniae can cause severe hemolytic uremic syndrome (HUS) in infants, leading to acute renal failure and death. Early diagnosis and treatment are crucial for better outcomes in pediatric HUS cases.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Microbiology
Background:
- Hemolytic uremic syndrome (HUS) is a leading cause of acute renal failure in children, often associated with Escherichia coli.
- Streptococcus pneumoniae is an uncommon but recognized cause of HUS, typically leading to more severe disease presentations.
Observation:
- This case study details an 8-month-old girl who developed HUS following pneumonia.
- Renal biopsy confirmed thrombotic microangiopathy and extensive cortical necrosis.
- The patient experienced severe sepsis from staphylococcal peritonitis despite peritoneal dialysis, leading to a fatal outcome.
Findings:
- Streptococcus pneumoniae-induced HUS, though rare, presents with significant severity in young patients.
- The patient exhibited characteristic thrombotic microangiopathy and acute renal failure.
- Complications included severe sepsis and peritonitis, contributing to mortality.
Implications:
- This case highlights the critical severity of Streptococcus pneumoniae-associated HUS in infants.
- There is a substantial long-term risk of end-stage kidney disease for survivors of HUS.
- Further research into the mechanisms and management of atypical HUS is warranted.
Abstract:
The hemolytic uremic syndrome (HUS), characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure, represents one of the major causes of acute renal failure in infancy and childhood. The typical form occurring after an episode of diarrhea caused by Escherichia coli is the most frequent in children. Other microorganisms also may be responsible for HUS, such as Streptococcus pneumoniae, which causes more severe forms of the disease. We report an 8-month-old girl who presented with pneumonia and subsequently developed HUS. Renal biopsy showed characteristic lesion of thrombotic microangiopathy and extensive cortical necrosis. She was managed with peritoneal dialysis but did not improve and developed severe sepsis due to staphylococcal peritonitis, resulting in the death of the patient. Streptococcus pneumoniae-induced HUS is uncommon, but results in severe disease in the young. There is a high risk of these patients developing end-stage kidney disease in the long term.
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