[Invasive pneumococcal disease and hemolytic uremic syndrome: new serotype]

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Hematology

Background:

• Streptococcus pneumoniae-associated hemolytic uremic syndrome (Sp-HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury following invasive Streptococcus pneumoniae infection.
• Early identification and management are crucial for favorable outcomes.

Observation:

• A 2-year-old boy presented with pneumonia and empyema, with Streptococcus pneumoniae (Sp) identified in blood and pleural fluid.
• Within 72 hours, the patient developed symptoms including anemia, thrombocytopenia, oliguria, and signs of hemolysis.

Findings:

• Laboratory results revealed anemia, low platelets, elevated creatinine and urea, schistocytes, and increased D-dimer, consistent with Sp-HUS.
• Urine analysis showed proteinuria and hematuria.
• Streptococcus pneumoniae serotype 38 was identified, marking the first reported association with Sp-HUS.

Implications:

• This case underscores the importance of considering Sp-HUS in children with invasive pneumococcal disease presenting with renal and hematological abnormalities.
• The identification of serotype 38 expands the understanding of bacterial serotypes implicated in Sp-HUS.
• Prompt diagnosis and supportive care, including mechanical ventilation and blood product transfusions, are vital for recovery.