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Article Details

Case Report

Volume 5, Issue 5 (May Issue)

A Rare Case of STEC-HUS Transitioned to Atypical HUS in a Renal Transplant Patient

Nikita Dahake1*, Shivani Shah2, Maitreyee Rai3 and Deep Shah3

1Department of Internal Medicine, Temple University, Philadelphia, PA, USA
2Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
3Department of Hematology/Oncology, Allegheny General Hospital, Pittsburgh, PA, USA

*Corresponding author: Nikita Dahake, Department of Internal Medicine, Temple University, Philadelphia, PA, USA. E-mail: nikita.dahake@tuhs.temple.edu

Received: April 04, 2023; Accepted: April 13, 2023; Published: May 05, 2023

Citation: Dahake N, Shah S, Rai M, Shah D. A Rare Case of STEC-HUS Transitioned to Atypical HUS in a Renal Transplant Patient. Clin Image Case Rep J. 2023; 5(4): 317.

A Rare Case of STEC-HUS Transitioned to Atypical HUS in a Renal Transplant Patient
Abstract

A 55-year-old male with history of end stage diabetic nephropathy with deceased donor kidney transplant on immunosuppression with tacrolimus and mycophenolate, presented with nausea, vomiting, and diarrhea. His labs showed anemia with peripheral blood schistocytosis, thrombocytopenia, low haptoglobin, elevated lactate dehydrogenase, and elevated creatinine. Stool cultures were positive for shiga toxin. He was diagnosed with STEC-HUS and managed conservatively, leading to an improvement in diarrhea and stabilization of hemoglobin and platelet count. However, kidney function continued to decline prompting a transplanted kidney biopsy confirming the diagnosis of TMA. Acute kidney injury eventually led to volume overload and uremic encephalopathy prompting initiation of hemodialysis. TMA laboratory results continued to decline, broadening the differential to atypical HUS versus refractory STEC-HUS. He was started on plasma exchange therapy while awaiting eculizumab procurement and then switched to eculizumab. There was marked improvement in kidney function and hemolysis parameters, and eventually was able to stop hemodialysis.

Keyword: Thrombotic microangiopathy; Atypical hemolytic uremic syndrome; Shiga-toxin; Eculizumab