Korean J Pediatr.  2014 Feb;57(2):96-99. 10.3345/kjp.2014.57.2.96.

Shiga toxin-associated hemolytic uremic syndrome complicated by intestinal perforation in a child with typical hemolytic uremic syndrome

• Chang HJ
• Kim HY
• Choi JH
• Choi HJ
• Ko JS
• Ha IS
• Cheong HI
• Choi Y
• Kang HG

• KMID: 1875969
• DOI: http://doi.org/10.3345/kjp.2014.57.2.96

Abstract

Hemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in childhood and is primarily diagnosed in up to 4.5% of children who undergo chronic renal replacement therapy. Escherichia coli serotype O157:H7 is the predominant bacterial strain identified in patients with HUS; more than 100 types of Shiga toxin-producing enterohemorrhagic E. coli (EHEC) subtypes have also been isolated. The typical HUS manifestations are microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency. In typical HUS cases, more serious EHEC manifestations include severe hemorrhagic colitis, bowel necrosis and perforation, rectal prolapse, peritonitis, and intussusceptions. Colonic perforation, which has an incidence of 1%-2%, can be a fatal complication. In this study, we report a typical Shiga toxin-associated HUS case complicated by small intestinal perforation with refractory peritonitis that was possibly because of ischemic enteritis. Although the degree of renal damage is the main concern in HUS, extrarenal complications should also be considered in severe cases, as presented in our case.

Keyword

Intestinal perforation; Hemolytic uremic syndrome; Shiga toxin; Typical

MeSH Terms

Acute Kidney Injury
Anemia, Hemolytic
Child*
Colitis
Colon
Enteritis
Enterohemorrhagic Escherichia coli
Escherichia coli
Hemolytic-Uremic Syndrome*
Humans
Incidence
Intestinal Perforation*
Intussusception
Necrosis
Peritonitis
Rectal Prolapse
Renal Insufficiency
Renal Replacement Therapy
Shiga Toxin
Thrombocytopenia
Shiga Toxin