Child Kidney Dis.  2015 Apr;19(1):48-52. 10.3339/chikd.2015.19.1.48.

A Case of Streptococcus pneumoniae associated Hemolytic Uremic Syndrome with DIC

• Kim SH
• Kim SY

• KMID: 2134414
• DOI: http://doi.org/10.3339/chikd.2015.19.1.48

Abstract

Streptococcus pneumoniae associated hemolytic uremic syndrome (SpHUS) is one of the causes of atypical hemolytic uremic syndrome, and increasingly reported. They are more severe and leave more long-term sequelae than more prevalent, typical hemolytic uremic syndrome. But it is not so easy to diagnose SpHUS for several reasons (below), and there was no diagnostic criteria of consensus. A 18 month-old-girl with sudden onset of oliguria and generalized edema was admitted through the emergency room. She had pneumonia with pleural effusion and laboratory findings of HUS, DIC, and positive direct Coombs' test. As DIC or SpHUS was suspected, we started to treat her with broad spectrum antibiotics, transfusion of washed RBC and replacement of antithrombin III. On the 3rd day, due to severe hyperkalemia and metabolic acidosis, continuous renal replacement therapy (CRRT) was started. She showed gradual improvement in 4 days on CRRT and discharged in 16 days of hospital care. At the follow up to one year, she has maintained normal renal function without proteinuria and hypertension. We report this case with review of articles including recently suggested diagnostic criteria of SpHUS.

Keyword

Hemolytic-Uremic Syndrome; Streptococcus pneumoniae; Disseminated intravascular coagulation; Child

MeSH Terms

Acidosis
Anti-Bacterial Agents
Antithrombin III
Child
Consensus
Coombs Test
Dacarbazine*
Disseminated Intravascular Coagulation
Edema
Emergency Service, Hospital
Follow-Up Studies
Hemolytic-Uremic Syndrome*
Humans
Hyperkalemia
Hypertension
Oliguria
Pleural Effusion
Pneumonia
Proteinuria
Renal Replacement Therapy
Streptococcus pneumoniae*
Anti-Bacterial Agents
Antithrombin III
Dacarbazine