Streptococcus pneumoniae-Associated Hemolytic Uremic Syndrome in a Splenectomized Adult Patient

A 62-year-old splenectomized woman was admitted because of upper respiratory tract symptoms, general fatigue, and purpura. Laboratory data demonstrated microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure, and a positive Streptococcus pneumoniae (SP) urinary antigen test. A renal...

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Bibliographic Details
Published inInternal Medicine Vol. 51; no. 15; pp. 2001 - 2005
Main Authors Maki, Nobuki, Komatsuda, Atsushi, Ohtani, Hiroshi, Kuroki, Jun, Nishinari, Tamio, Asakura, Kenichi, Sawada, Kenichi, Wakui, Hideki
Format Journal Article
LanguageEnglish
Published Japan The Japanese Society of Internal Medicine 01.01.2012
Subjects
Acute Kidney Injury - drug therapy
Acute Kidney Injury - etiology
adult patient
Anti-Bacterial Agents - administration & dosage
Antibiotics
Biopsy
Data processing
Etiology
Fatigue
Female
Hemodialysis
Hemolytic anemia
Hemolytic uremic syndrome
Hemolytic-Uremic Syndrome - drug therapy
Hemolytic-Uremic Syndrome - etiology
Hemolytic-Uremic Syndrome - pathology
Humans
Infection
Kidney
methylprednisolone
Middle Aged
Pneumococcal Infections - complications
Pneumococcal Infections - drug therapy
Pneumococcal Infections - etiology
postsplenectomy infection
Purpura
renal biopsy
Renal failure
Respiratory tract
Splenectomy - adverse effects
steroid pulse therapy
Steroids - administration & dosage
Streptococcus
Streptococcus pneumoniae
Substance P
Thrombocytopenia
Thrombotic Microangiopathies - etiology
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Summary:A 62-year-old splenectomized woman was admitted because of upper respiratory tract symptoms, general fatigue, and purpura. Laboratory data demonstrated microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure, and a positive Streptococcus pneumoniae (SP) urinary antigen test. A renal biopsy showed thrombotic microangiopathic changes. She was diagnosed with hemolytic uremic syndrome (HUS) secondary to SP infection. Methylprednisolone pulse therapy in addition to antibiotic therapy led to prompt improvement of her symptoms and laboratory abnormalities. This is the first adult case of SP-associated HUS successfully treated without hemodialysis. SP infection should be considered as a causative etiology in all splenectomized patients with HUS.
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ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.51.7916