S. Pneumoniae Infection Associated with a Hemolytic Uremic Syndrome in an Adult Patient: A Case Report
Journal Title: Journal of Case Reports and Studies - Year 2018, Vol 6, Issue 2
Abstract
Hemolytic uremic syndrome (HUS) is a rare but severe entity characterized by the triad of acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia. This disease is frequently observed in children after a diarrhea process secondary to Escherichia coli O157: H7. However, other disturbs may generate this disease, including pneumonia secondary to S. pneumoniae, which represents around 5% of all HUS cases. This type of HUS has demonstrated an increase in incidence in the population recently. We report a case of an 83-years-old with hypothermia (33 o C) after being found at home on the floor. The blood revealed a severe anemia (hemoglobin 4.8 g/dL; hematocrit 15.3%; red blood cell count 1.54×1012/L), hemolysis (lactate dehydrogenase 615 U/L; potassium 5.8 mmol/L), acute renal failure (creatinine 4.22 mg/dL; urea 174 mg/dL), and thrombocytopenia (platelet count 57×109/L). The peripheral smear was notable for toxic granulation in the neutrophils, large platelets, target cells, microspherocytes, and schistocytes. A chest X-ray showed right-sided lower lobe pneumonia, isolating S. pneumoniae infection in the urine culture. Due to the critical situation of the patient, intense fluid therapy, vasoactive drugs (dopamine), and temperature control by physical measurements was initiated as treatment. The evolution of the patient after the beginning of the treatment was torpid, resulting in a cardiorespiratory arrest and death. The prognosis of patients with pneumococcal-HUS is strongly dependent on the effectiveness of antibiotic therapy as well as supportive intensive care (including steroids pulse therapy). Early recognition and prompt initiation of antibiotics with supportive intensive care may improve the outcome.
Authors and Affiliations
Esteban-Zubero E
Keywords
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- EP ID EP584747
- DOI 10.15744/2348-9820.6.204
- Views 96
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