Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. May 4, 2017; 6(2): 135-139
Published online May 4, 2017. doi: 10.5492/wjccm.v6.i2.135
Hemolytic uremic syndrome in adults: A case report
Fabiel Gerardo Pérez-Cruz, Patricia Villa-Díaz, María Consuelo Pintado-Delgado, María Loreto Fernández_Rodríguez, Ana Blasco-Martínez, María Pérez-Fernández
Fabiel Gerardo Pérez-Cruz, Internal Medicine Department, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco SN, 28805 Madrid, Spain
Patricia Villa-Díaz, María Consuelo Pintado-Delgado, Critical Care Unit, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco SN, 28805 Madrid, Spain
María Loreto Fernández_Rodríguez, María Pérez-Fernández, Nephrology Department, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco SN, 28805 Madrid, Spain
Ana Blasco-Martínez, Pathological Anatomy Department, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco SN, 28805 Madrid, Spain
Author contributions: Pérez-Cruz FG, Villa-Díaz P and Pintado-Delgado MC wrote the paper; Pérez-Cruz FG, Villa-Díaz P, Pintado-Delgado MC, Fernández_Rodríguez ML, Blasco-Martínez A and Pérez-Fernández M performed the research; Fernández_Rodríguez ML, Blasco-Martínez A and Pérez-Fernández M reviewed the current knowledge.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics and Clinical Trials Committee Principe de Asturias University Hospital.
Informed consent statement: The patient involved in this case has given written consent to report this case.
Conflict-of-interest statement: None of the authors received financial support for participating in this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: María Consuelo Pintado-Delgado, MD, PhD, Critical Care Unit, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco SN, Alcalá de Henares, 28805 Madrid, Spain. consuelopintado@yahoo.es
Telephone: +34-91-8878100-2205 Fax: +34-91-8833430
Received: January 19, 2017
Peer-review started: January 19, 2017
First decision: March 8, 2017
Revised: March 23, 2017
Accepted: April 6, 2017
Article in press: April 8, 2017
Published online: May 4, 2017
Abstract

Thrombotic microangiopathies (TMA) are microvascular occlusive disorders characterized by platelet aggregation and mechanical damage to erythrocytes, clinically characterized by microangiopatic haemolytic anemia, thrombocytopenia and organ injury. We are reporting a case of a woman patient with severe hemolytic uremic syndrome associated to infectious diarrhoea caused by Shiga toxin-producing pathogen, who were admitted to our intensive care unit. The patient described developed as organ injury, neurological failure and acute renal failure, with need of haemodialysis technique. Due to the severity of the case and the delay in the results of the additional test that help us to the final diagnose, we treated her based on a syndromic approach of TMA with plasma exchange, with favourable clinical evolution with complete recovery of organ failures. We focus on the syndromic approach of these diseases, because thrombotic thrombocytopenic purpura, one of the disorders that are included in the syndromes of TMA, is considered a haematological urgency given their high mortality without treatment; and also review the TMA in adults: Their pathogenesis, management and outcomes.

Keywords: Hemolytic uremic syndrome, Eculizumab, Thrombotic microangiopathies, Plasma exchange, Adult

Core tip: This case report of an adult patient with thrombotic microangiopathy associated to infectious diarrhoea caused by Shiga toxin-producing pathogen, shows the syndromic approach of thrombotic microangiopathies in adults, with a review of pathogenesis and management of this diseases.