Yonsei Med J.  2006 Jun;47(3):437-439. 10.3349/ymj.2006.47.3.437.

A Case of Hemolytic Uremic Syndrome Caused by Escherichia coli O104:H4

• Bae WK
• Lee YK
• Cho MS
• Ma SK
• Kim SW
• Kim NH
• Choi KC

• KMID: 1715866
• DOI: http://doi.org/10.3349/ymj.2006.47.3.437

Abstract

A 29-year-old woman presented with bloody diarrhea, abdominal pain, hemolytic anemia, thrombocytopenia, and acute renal failure. She was diagnosed with Escherichia coli O104:H4-associated hemolytic-uremic syndrome (HUS) and treated with plasmapheresis and hemodialysis for 3 weeks. She recovered without sequelae. To the best of our knowledge, this is the first report of Escherichia coli O104:H4-associated HUS in Korea. We recommend that Escherichia coli O104:H4, as well as the more common O157:H7, be considered in the diagnosis of bloody diarrhea-associated HUS.

Keyword

Hemolytic uremic syndrome; E. coli

MeSH Terms

Humans
Hemolytic-Uremic Syndrome/*microbiology
Female
Escherichia coli Infections/*complications
Escherichia coli/*classification
Adult

Figure

• 

  Fig. 1 Peripheral blood smear showed polychromasia, anisocytosis and schistocytes, consistent with microangiopathic hemolytic anemia (hematoxylin and eosin, × 400).

Reference

1. Verweyen HM, Karch H, Allerberger F, Zimmerhackl LB. Enterohemorrhagic Escherichia coli (EHEC) in pediatric hemolytic uremic syndrome: a prospective study in Germany and Austria. Infection. 1999. 27:341–347.

2. Caprioli A, Tozzi AE, Rizzoni G, Karch H. Non-O157 Shiga toxin-producing Escherichia coli infections in Europe. Emerg Infect Dis. 1997. 3:578–579.

3. Kim YB, Okuda J, Matsumoto C, Morigaki T, Asai N, Watanabe H, et al. Isolation of an Escherichia coli O157:H7 strain producing Shiga toxin 1 but not Shiga toxin 2 from a patient with hemolytic uremic syndrome in Korea. FEMS Microbiol Lett. 1998. 166:43–48.

4. Cho YH, Park HJ, Song KS, Song YG, Lee SI, Park IS. A Case of Hemolytic Uremic Syndrome Caused by Escherichia coli O8: Case Report. Korean J Gastrointest Endosc. 2002. 25:213–216.

5. Mead PS, Griffin PM. Escherichia coli O157:H7. Lancet. 1998. 352:1207–1212.

6. Repetto HA. Epidemic hemolytic-uremic syndrome in children. Kidney Int. 1997. 52:1708–1719.

7. Banatvala N, Griffin PM, Greene KD, Barrett TJ, Bibb WF, Green JH, et al. The United States National Prospective Hemolytic Uremic Syndrome Study: microbiologic, serologic, clinical, and epidemiologic findings. J Infect Dis. 2001. 183:1063–1070.

8. Elliott EJ, Robins-Browne RM, O'Loughlin EV, Bennett-Wood V, Bourke J, Henning P, et al. Nationwide study of haemolytic uraemic syndrome: clinical, microbiological, and epidemiological features. Arch Dis Child. 2001. 85:125–131.

9. Boyce TG, Swerdlow DL, Griffin PM. Escherichia coli O157:H7 and the hemolytic-uremic syndrome. N Engl J Med. 1995. 333:364–368.

10. Su C, Brandt LJ. Escherichia coli O157:H7 infection in humans. Ann Intern Med. 1995. 123:698–714.

11. Meng J, Zhao S, Doyle MP. Virulence genes of Shiga toxin-producing Escherichia coli isolated from food, animals and humans. Int J Food Microbiol. 1998. 45:229–235.

12. Willshaw GA, Scotland SM, Smith HR, Rowe B. Properties of Vero cytotoxin-producing Escherichia coli of human origin of O serogroups other than O157. J Infect Dis. 1992. 166:797–802.

13. Scotland SM, Rowe B, Smith HR, Willshaw GA, Gross RJ. Vero cytotoxin-producing strains of Escherichia coli from children with haemolytic uraemic syndrome and their detection by specific DNA probes. J Med Microbiol. 1988. 25:237–243.

14. Pierard D, Stevens D, Moriau L, Lior H, Lauwers S. Isolation and virulence factors of verocytotoxin-producing Escherichia coli in human stool samples. Clin Microbiol Infect. 1997. 3:531–540.

15. Kaplan BS, Meyers KE, Schulman SL. The pathogenesis and treatment of hemolytic uremic syndrome. J Am Soc Nephrol. 1998. 9:1126–1133.

16. Rock GA, Shumak KH, Buskard NA, Blanchette VS, Kelton JG, Nair RC, et al. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. N Engl J Med. 1991. 325:393–397.

17. Dundas S, Murphy J, Soutar RL, Jones GA, Hutchinson SJ, Todd WT. Effectiveness of therapeutic plasma exchange in the 1996 Lanarkshire Escherichia coli O157:H7 outbreak. Lancet. 1999. 354:1327–1330.

18. McLeod BC. Introduction to the third special issue: clinical applications of therapeutic apheresis. J Clin Apheresis. 2000. 15:1–5.