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Case Report: Severe form of hemolytic-uremic syndrome with multiple organ failure in a child: a case report
Dino Mijatovic1, Ana Blagaic1, Zeljko Zupan1
1Department of Anesthesiology and Critical Care, University Hospital Rijeka, Rijeka, Croatia.
Insights
Severe hemolytic-uremic syndrome (HUS) in a child, characterized by multiple organ failure, was successfully treated with plasmapheresis and intensive care. Early intervention is key for recovery in critical HUS cases.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
Background:
- Hemolytic-uremic syndrome (HUS) is a primary cause of acute renal failure in children.
- Typical HUS involves acute renal failure, hemolytic anemia, and thrombocytopenia post-enterocolitis.
- Severe HUS can lead to acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF).
Purpose of the Study:
- To present a case study of severe HUS in a pediatric patient.
- To highlight the effectiveness of intensive care and plasmapheresis in managing severe HUS with MOF.
Main Methods:
- A case report of a 4-year-old girl diagnosed with typical HUS.
- Treatment involved intensive care unit (ICU) support, plasmapheresis, and continuous veno-venous hemodialysis.
- Monitoring of prognostic factors for timely interventions.
Main Results:
- The patient developed severe MOF, including ileus, pancreatitis, hepatitis, coma, and ARDS.
- Significant improvement was observed following plasmapheresis and hemodialysis.
- The child achieved a complete recovery after one month.
Conclusions:
- Early plasmapheresis and intensive supportive care, including renal replacement therapy, are crucial for severe HUS with MOF.
- Prognostic factor monitoring aids in early diagnostic and therapeutic interventions.
Introduction:
Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF).
Case Presentation:
A previously healthy 4-year old Caucasian girl developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. By the end of the first week the diagnosis of the typical HUS was established. During the second week the disease progressed into MOF that included ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after one month of the disease. She was successfully treated in the intensive care unit and significant improvement was noticed after plasmapheresis and continuous veno-venous hemodialysis.
Conclusions:
Early start of plasmapheresis and meticulous supportive treatment in the intensive care unit, including renal placement therapy, may be the therapy of choice in severe cases of HUS presented by MOF. Monitoring of prognostic factors is important for early performance of appropriate diagnostic and therapeutical interventions.
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