An Unusual Case of Clostridium Difficile Colitis and Hemolytic Uremic Syndrome in a Teenager.

The term hemolytic uremic syndrome (HUS) refers to a heterogenous group of disorders arising from an initial endothelial cell injury with fibrin and platelet thrombi formation in the vasculature, leading to severe organ damage resulting in the well-known triad of microangiopathic hemolytic anemia, thrombocytopenia and kidney disease. The majority of pediatric cases (90 percent) of HUS are caused by Shiga toxin-producing Escherichia coli (STEC-HUS) or Shigella dysenteriae and rarely with Streptococcus pneumoniae (Pneumococcal-HUS). Atypical hemolytic uremic syndrome (aHUS) constitute only 5 percent of all HUS cases and are mediated by dysregulation of complement proteins. Supportive therapy is the cornerstone of management of HUS. Atypical HUS on the other hand is amenable to treatment with eculizumab; the first FDA approved complement blocker. We present a case of HUS caused by Clostridium difficile in a 16-year-old pediatric patient which has rarely been mentioned in the literature and is the first reported case successfully treated with eculizumab with rapid and sustained improvement in hematologic and kidney disease.

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