Management of atypical Hemolytic-Uremic Syndrome in gravida with SARS-COVID-2 infection

ABSTRACT

Background. Coronavirus disease is a highly contagious infection that can be deadly and is caused by the severe acute respiratory syndrome SARS-CoV-2.The current literature indicates that pregnancy may worsen the course of COVID-19 infection compared to non pregnant women at the same age. Atypical hemolytic uremic syndrome (aHUS) is a complement-mediated disorder, characterized by microangiopathic hemolysis, thrombocytopenia, and renal failure. Case presentation. A case of a gravida at 20 weeks of gestation with worsening clinical conditions due to aHUS, and SARS-COV-2 infection was managed. Continuous renal replacement therapies with transfusion of plasma was started. Diagnosis comprised atypical HELLP presentation with progressive reduction of PLT levels versus other thrombotic microangiopathy. Conclusions. The lack of anti-ADAMTS 13 antibodies allowed to make the diagnosis of Hemolytic-Uremic Syndrome (HUS). The patient started therapy with Eculizumab 900 mg that was administered one time every 7 days. The patient resumed spontaneous urination after one day of therapy. Renal failure persisted after 5 days with creatinine levels at 7.9 mg/dL and azotemia at 126 mg/dL. It is challenging to predict the impact of immune-mediated therapies on pregnant women. Furthermore, additional data about the immunomodulatory changes in COVID-19 patients during pregnancy may reveal pathophysiological events behind this deadly disease.