Download PDF
CC BY 4.0 · Journal of Child Science 2020; 10(01): e221-e223
DOI: 10.1055/s-0040-1721450
Case Report

Pediatric Pneumococcal Hemolytic Uremic Syndrome Treated with Sequence Tandem Therapeutic Plasma Exchange and Continuous Venovenous Hemodiafiltration: A Case Report

Josko Markic
1   Department of Pediatrics, University Hospital of Split, Split, Croatia
2   Department of Pediatrics, University of Split School of Medicine, Split, Croatia
,
Branka Polic
1   Department of Pediatrics, University Hospital of Split, Split, Croatia
2   Department of Pediatrics, University of Split School of Medicine, Split, Croatia
,
Tanja Kovacevic
1   Department of Pediatrics, University Hospital of Split, Split, Croatia
,
Marijana Rogulj
1   Department of Pediatrics, University Hospital of Split, Split, Croatia
,
Tatjana Catipovic Ardalic
1   Department of Pediatrics, University Hospital of Split, Split, Croatia
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Approximately 5% of HUS cases are associated with Streptococcus pneumoniae infections (pHUS). Treatment includes supportive care with appropriate antimicrobial therapy, fluid and blood product resuscitation, and renal replacement therapy. We presented a case of a 22-month-old previously healthy girl, who was hospitalized at University Hospital of Split. Left-sided pneumonia and sepsis caused by S. pneumoniae were confirmed. The course of illness was complicated with development of pHUS. Since the pathogenesis of pHUS is only partially understood, the treatment remains controversial. Our patient was successfully treated with daily sequence tandem continuous venovenous hemodiafiltration and therapeutic plasma exchange with albumins, along with other supportive measures. Therefore, in our opinion, plasmapheresis should be considered as a part of standard treatment of children with pHUS. Additionally, the incidence of pHUS appears to be increasing. S. pneumoniae is a particularly important among pediatric pathogens and it can cause wide spectrum of illnesses. Therefore, due to the significant burden of invasive pneumococcal disease, pneumococcal vaccination should be encouraged.

Keywords

hemolytic uremic syndrome - child - streptococcus pneumonia - plasmapheresis - therapeutic


Publication History

Received: 13 September 2020

Accepted: 20 October 2020

Article published online:
02 December 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Fakhouri F, Zuber J, Frémeaux-Bacchi V, Loirat C. Haemolytic uraemic syndrome. Lancet 2017; 390 (10095): 681-696
    CrossrefPubMedGoogle Scholar
  • 2 Raina R, Krishnappa V, Blaha T. et al. Atypical hemolytic-uremic syndrome: an update on pathophysiology, diagnosis, and treatment. Ther Apher Dial 2019; 23 (01) 4-21
    CrossrefPubMedGoogle Scholar
  • 3 Cody EM, Dixon BP. Hemolytic uremic syndrome. Pediatr Clin North Am 2019; 66 (01) 235-246
    CrossrefPubMedGoogle Scholar
  • 4 Spinale JM, Ruebner RL, Kaplan BS, Copelovitch L. Update on Streptococcus pneumoniae associated hemolytic uremic syndrome. Curr Opin Pediatr 2013; 25 (02) 203-208
    CrossrefPubMedGoogle Scholar
  • 5 Banerjee R, Hersh AL, Newland J. et al; Emerging Infections Network Hemolytic-Uremic Syndrome Study Group. Streptococcus pneumoniae-associated hemolytic uremic syndrome among children in North America. Pediatr Infect Dis J 2011; 30 (09) 736-739
    CrossrefPubMedGoogle Scholar
  • 6 Scobell RR, Kaplan BS, Copelovitch L. New insights into the pathogenesis of Streptococcus pneumoniae-associated hemolytic uremic syndrome. Pediatr Nephrol 2019; DOI: 10.1007/s00467-019-04342-3.
    CrossrefPubMedGoogle Scholar
  • 7 Salvadori M, Bertoni E. Update on hemolytic uremic syndrome: diagnostic and therapeutic recommendations. World J Nephrol 2013; 2 (03) 56-76
    CrossrefPubMedGoogle Scholar
  • 8 Lawrence J, Gwee A, Quinlan C. Pneumococcal haemolytic uraemic syndrome in the postvaccine era. Arch Dis Child 2018; 103 (10) 957-961
    CrossrefPubMedGoogle Scholar
  • 9 Klein PJ, Bulla M, Newman RA. et al. Thomsen-Friedenreich antigen in haemolytic-uraemic syndrome. Lancet 1977; 2 (8046): 1024-1025
    CrossrefPubMedGoogle Scholar
  • 10 Loirat C, Saland J, Bitzan M. Management of hemolytic uremic syndrome. Presse Med 2012; 41 (3 Pt 2): e115-e135
    CrossrefPubMedGoogle Scholar
  • 11 Copelovitch L, Kaplan BS. Streptococcus pneumoniae-associated hemolytic uremic syndrome. Pediatr Nephrol 2008; 23 (11) 1951-1956
    CrossrefPubMedGoogle Scholar
  • 12 Schwartz J, Padmanabhan A, Aqui N. et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society for Apheresis: the seventh special issue. J Clin Apher 2016; 31 (03) 149-162
    CrossrefPubMedGoogle Scholar
  • 13 Szilágyi A, Kiss N, Bereczki C. et al. The role of complement in Streptococcus pneumoniae-associated haemolytic uraemic syndrome. Nephrol Dial Transplant 2013; 28 (09) 2237-2245
    CrossrefPubMedGoogle Scholar
  • 14 Gilbert RD, Nagra A, Haq MR. Does dysregulated complement activation contribute to haemolytic uraemic syndrome secondary to Streptococcus pneumoniae?. Med Hypotheses 2013; 81 (03) 400-403
    CrossrefPubMedGoogle Scholar