Atypical HUS with multiple complement system mutations triggered by synthetic psychoactive drug abuse: a case report

Area of Science:

• Nephrology
• Immunology
• Genetics

Background:

• Atypical hemolytic uremic syndrome (aHUS) is a rare thrombotic microangiopathy.
• It results from dysregulation of the alternative pathway of the complement system.
• Triggers include infections, pregnancy, and autoimmune conditions, with idiopathic cases comprising ~30%.

Observation:

• A patient presented with clinical features of aHUS.
• Genetic analysis revealed mutations in the C3-complement system.
• The onset of aHUS coincided with the use of a novel synthetic psychoactive drug.

Findings:

• The patient's C3-complement system mutations predisposed them to complement overactivation.
• The synthetic psychoactive drug acted as an environmental trigger for aHUS in this genetically susceptible individual.
• This case establishes a new potential drug-induced etiology for aHUS.

Implications:

• This case expands the known spectrum of aHUS triggers.
• It underscores the importance of considering drug-induced causes in unexplained aHUS.
• Genetic screening for complement system mutations may be warranted in patients with drug-associated aHUS.