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- Title
Hemolytic uremic syndrome associated with Escherichia coli O157:H7 infection in older adults: a case report and review of the literature.
- Authors
Heidi Ko; Maymani, Hossein; Rojas-Hernandez, Cristhiam; Ko, Heidi
- Abstract
<bold>Background: </bold>Hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli O157:H7 has been widely known as a common cause of acute renal failure in children. There are only a few reports of sporadic Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome in adults in the USA. Analyses from the 2011 outbreak of hemolytic uremic syndrome associated with Escherichia coli O104:H4 reported that mortality rates are highest in those patients with age >60-years old. Therefore, recognizing Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome in older people can help early introduction of the appropriate therapy.<bold>Case Presentation: </bold>We describe an 86-year-old Caucasian woman, initially treated as suspected thrombotic thrombocytopenic purpura, with worsening neurological and renal functions despite plasmapheresis (plasma exchange). A subsequent normal ADAMTS13 activity level and positive stool sample for Escherichia coli O157:H7 confirmed the diagnosis of Shiga toxin-associated hemolytic uremic syndrome. We shifted our management towards aggressive supportive care. Despite conventional treatment, hemolytic uremic syndrome unfortunately led to her death.<bold>Conclusions: </bold>Our case demonstrates the importance of recognizing Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome as an etiology of microangiopathic hemolytic anemia in older people. According to the current literature, supportive care is the best approach for Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome. Therapies such as plasma exchange and eculizumab (a complement inhibitor) are not shown to be effective in Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome. There is a dire need to continue research to find better treatment options in this disease entity with a high mortality, particularly in older people.
- Subjects
ESCHERICHIA coli; ESCHERICHIA; COLIFORMS; OLDER people; ADULTS; DIAGNOSIS of escherichia coli diseases; TREATMENT of escherichia coli diseases; HEMOLYTIC-uremic syndrome treatment; HEMOLYTIC-uremic syndrome diagnosis; DIFFERENTIAL diagnosis; ESCHERICHIA coli diseases; HEMOLYTIC-uremic syndrome; PALLIATIVE treatment; TREATMENT effectiveness; DISEASE complications
- Publication
Journal of Medical Case Reports, 2016, Vol 10, p1
- ISSN
1752-1947
- Publication type
journal article
- DOI
10.1186/s13256-016-0970-z