Adult nondiarrhea hemolytic uremic syndrome associated with Shiga toxin Escherichia coli
Adult nondiarrhea hemolytic uremic syndrome associated with Shiga toxin Escherichia coli O157:H7 bacteremia and urinary tract infection. Chiurchiu C, Firrincieli A, Santostefano M, Fusaroli M, Remuzzi G, Ruggenenti P. American Journal of Kidney Diseases 2003;41(1):E4.
About 15% of children with Shiga toxin (Stx) producing Escherichia coli (STEC) primarily of serotype O157:H7, gastrointestinal infection, and watery or bloody diarrhea, may develop hemolytic uremic syndrome (HUS). Usually diarrhea-associated (D+) HUS is not complicated by bacteremia and patients recover spontaneously without antibiotic treatment. This paper reports on an adult case of a STEC O157:H7 urinary tract infection complicated by bacteremia and HUS that was not preceded by diarrhea (D- HUS). A 25-year-old woman was hospitalized with fever, vomiting, and gross hematuria. At admission she reported decreased urine output, reduced vision in the left eye, and epistaxis. Her temperature and pulse rate were increased but she was not hypertensive. Laboratory testing revealed leukocytosis, thrombocytopenia, microangiopathic hemolytic anemia, and renal insufficiency, among other abnormalities. A presumptive diagnosis of D-HUS was made and a course of daily hemodialysis and plasma exchange was started. E. coli O157:H7 was found in blood and urine cultures but not in stool cultures. Antibiotic treatment was changed from the initial multidrug regimen to ciprofloxacin therapy after culture results were determined. Dialysis was stopped 13 days after hospitalization. The patient fully recovered and at 15 months after disease onset, she was without sequelae. Cases of D- HUS need to be carefully examined for foci other than the gastrointestinal tract, and patients with E coli bacteremia should receive early antibiotic treatment, as would any patient with sepsis.