Extracorporeal Membrane Oxygenation and Eculizumab for Cardiac Failure in STEC-HUS

Hemolytic uremic syndrome (HUS) is a complication of Shiga toxin-producing Escherichia coli (STEC) infection that can cause acute renal failure and introduce serious extrarenal organ injury. The most life threatening of these include cardiac failure and thrombocytopenia. Here, we present a case of severe STEC-HUS in a previously healthy 2-year-old boy who progressed to cardiac failure necessitating extracorporeal membrane oxygenation (ECMO). Following ECMO cannulation, he was treated with eculizumab, an anticomplement component 5 monoclonal antibody. The patient required ECMO for 5 days and subsequently survived decannulation with normal cardiac function and a good neurological outcome. This case illustrates the feasibility of ECMO despite the consumptive thrombocytopenia characteristic of HUS as well as the potential role of eculizumab in facilitating cardiac recovery. Additionally, we propose anticoagulation parameters balancing HUS-related thrombocytopenia with hemorrhagic complications while on ECMO. Further studies are warranted to better understand complement dysregulation in the pathophysiology of STEC-HUS and develop treatment guidelines for STEC-HUS with cardiac manifestations.