Abstract: PUB021
Atypical Case of Hemolytic Uremic Syndrome Caused by Shiga Toxin-Producing Aeromonas Species
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Author
- Kreik, Soloman, San Ysidro Health, San Diego, California, United States
Introduction
Hemolytic uremic syndrome (HUS) is a leading cause of acute kidney injury in infants and young children, rarely effecting adults. It is defined as a triad of renal insufficiency, hemolytic anemia, and thrombocytopenia associated with shiga-like toxin (SLT). SLT is an antigen associated with diarrhea and plays a role in the pathogenesis of HUS. Commonly, the toxin is produced by E. Coli or Shigella species; however, recent studies show active SLT produced by Aeromonas spp. We present an atypical case of HUS caused by SLT producing A. hydrophila.
Case Description
A 77 year old female with past medical history of hypertension presented with one day of worsening lethargy. The patient complained of bloody diarrhea and diffuse abdominal pain. She endorsed eating raw oysters a day prior. On examination her abdomen was diffusely tender to palpation. Initial labs revealed a creatinine of 3.1 hemoglobin of 10.1 and a platelet count of 102. CBC and CMP were otherwise unremarkable. The patient was bolused with normal saline and started on maintenance fluids. Peripheral blood smear returned with schistocytes, LDH was elevated at 346 and haptoglobin was low at 28. The patient’s stool antigens returned positive for Shiga toxin and blood culture showed Aeromonas Hydrophila bacteremia. At day 9 the patient’s renal function subsequently returned to baseline.
Discussion
HUS is a microvascular occlusive disease that damages the glomeruli due to accumulation of platelets and sheared red blood cells. Isolation of A. hydrophila producing SLTs is concerning, as these toxins are associated with HUS. Aeromonas spp. producing SLTs could be an emergent pathogen in the pathophysiology fo HUS. This was a rare phenomenon, which is now proven by PCR amplification of the stx1 and stx2 gene in many similar cases. Our patient’s HUS diagnosis demonstrated a prodromal illness of diarrhea, development of renal failure, thrombocytopenia and anemia. Early identification will allow prompt management and the prevention of long-standing renal failure.
Lab results on admission
| Test | Patient | Reference range |
| Creatinine | 3.1 mg/dL | 0.6 – 1.1 mg/dL |
| Hemoglobin | 10.1 g/dL | 11.6 – 15 g/dL |
| Platelet count | 102,000 μL | 150,000 – 450,000 μL |
| LDH | 346 U/L | 140 – 280 U/L |
| Haptoglobin | 28 mg/dL | 41 – 165 mg/dL |