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- Title
Constipation and hemolytic uremic syndrome.
- Authors
Crawford, Brendan; Strebeck, Paige; Saccente, Suzanne
- Abstract
Background: Shiga toxin-producing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) classically presents with diarrhea. Absence of diarrheal prodrome increases suspicion for atypical HUS (aHUS). Inability to obtain a fecal specimen for culture or culture-independent testing limits the ability to differentiate STEC-HUS and aHUS. Case-diagnosis/treatment: Our patient presented with abdominal pain and constipation, and evaluation of pallor led to a diagnosis of HUS. There was a complete absence of diarrhea during the disease course. Lack of fecal specimen for several days delayed testing for STEC. Treatment for atypical HUS was initiated with complement-blockade therapy. PCR-testing for Shiga toxin from fecal specimen later returned positive. Alternative complement-pathway testing did not identify a causative genetic variant or anti-Factor H antibody. A diagnosis of STEC-HUS was assigned, and complement-blockade therapy was stopped. Conclusion: Diagnosis of aHUS remains a diagnosis of exclusion, whereby other causes of HUS are eliminated with reasonable certainty. Exclusion of STEC is necessary and relies on testing availability and recognition of testing limitations. Diarrhea-negative STEC-HUS remains a minority of cases, and future research is needed to explore the clinical characteristics of these patients.
- Subjects
DIAGNOSIS of diarrhea; DIAGNOSIS of escherichia coli diseases; HEMOLYTIC-uremic syndrome diagnosis; HEMOLYTIC-uremic syndrome treatment; ESCHERICHIA coli; CLINICAL pathology; DIARRHEA; CONSTIPATION; ESCHERICHIA coli diseases; CHILD psychopathology; ABDOMINAL pain; HEMOLYTIC-uremic syndrome; DISEASE complications
- Publication
Pediatric Nephrology, 2024, Vol 39, Issue 2, p603
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-023-06093-8