Atypical hemolytic uremic syndrome associated with pregnancy: A case report

Hemolytic uremic syndrome (HUS) is a microangiopathy characterized by hemolytic anemia, thrombocytopenia and acute renal failure. It affects 2 to 3 individuals per 100,000 in the population, with a higher prevalence among adult women. HUS is caused by the abnormal activation of the complement system, leading to endot2helial damage and the formation of microthrombi in renal capillaries, which determines the severity of the condition. Pregnancy may predispose individuals to HUS due to changes in the maternal immune system. The present study describes the case of a 29-year-old female patient who presented postpartum with purulent discharge, severe anemia (hemoglobin level, 4.6 g/dl), thrombocytopenia, acute kidney injury (creatinine level, 10.6 mg/dl) and elevated levels of lactate dehydrogenase (1,450 U/l). Despite antibiotic therapy and blood transfusions, she developed anuria, metabolic acidosis and acute pulmonary edema, requiring admission to the intensive care unit and mechanical ventilation. A peripheral blood smear revealed >10 schistocytes per high-power field. A kidney biopsy confirmed HUS. Following stabilization with plasma infusions, corticosteroids and supportive care, she was discharged with intermittent hemodialysis and continues under nephrology follow-up. On the whole, HUS is a rare condition that is increasingly recognized. The case presented herein highlights the rapid clinical progression of this condition, emphasizing the importance of diagnostic suspicion to reduce mortality and improve prognosis.