Hemolytic Uremic Syndrome Following a Severe Colitis

ABSTRACT

The hemolytic uremic syndrome consists of microangiopathic hemolytic anemia, acute renal failure, and thrombocytopenia following a prodromal illness of gastroenteritis or upper respiratory infection. Sometimes, the syndrome can present in a dramatic fashion with severe abdominal pain and signs of intestinal obstruction, suggesting an intussusception or acute surgical crisis. A 2-year-old girl with a 3-day history of several episodes of bloody-mucoid diarrhea and severe abdominal pain was admitted under suspicion of intussusception. Her symptoms started 4 days after eating a pork and X-ray revealed the distended small bowel without a large bowel gas pattern. Colitis without perforation was found by abdominal ultrasonogram and sigmoidoscope. Unfortunately, she became pallor, puffy, and oliguric 7 days later. Clues to the diagnosis of hemolytic uremic syndrome in the early stages of the acute illness were oliguria, abnormal peripheral blood smear, anemia despite dehydration, and proteinuria. The onset is usually preceded by symptoms of gastroenteritis, such as fever, vomiting, abdominal pain, and bloody diarrhea. This is followed in 5 to 10 days by a sudden onset of pallor, irritability, weakness, lethargy, and oliguria. The majority of patients recover normal renal function with aggressive management of the acute renal failure. Careful medical management of the hematologic and renal manifestations, in conjunction with early and frequent peritoneal dialysis, offers the best chance of recovery from the acute phase. The present patient was recovered by apropriate fluid and electrolyte management, transfusions of packed RBCs, fresh frozen plasma, and early application of peritoneal dialysis.