A 14-year-old woman with no relevant personal history.
After returning from a trip to Istanbul, she begins with an episode of diarrheal stools with mucous-nolent characteristics (14-15 stools/day) accompanied by vomiting, abdominal pain, weakness.
After the persistence of this clinic for five days, begins with hematuria and oligoanuria coming to our hospital, where analytical study of hemophilia is detected without glomerular bilirrubin (BD hemoglobin: BD84 mg/dl), platelet deterioration
suspected HUS transfusion was performed again analytical control with blood smear, showing severe worsening both clinically and analytically: creatinine: 2.6 mg/dl, platelets: 39,000 mm3, hemoglobin: 7 g/dl).
Schistocytes were found in the blood smear and a negative coprocultive test for Shiga toxin was performed.
Immunological study was performed with immunoglobulins, complement, antineutrophil cytoplasmic antibodies, antinuclear antibodies, glomerular basal antime antibody, which was negative, ruling out systemic disease.
These data are diagnosed with HUS and support measures are initiated with serum therapy and plasmapheresis session through a right femoral transient catheter, and prednisone (1 mg/kg/weight) is added to the treatment.
During the first seven days, the evolution was torpid with no response to daily plasmapheresis sessions and worsening of the clinical symptoms starting with an abrupt decrease in platelet count (19,000 with anuria).
He needed three hemodialysis sessions.
In the eleventh session of daily plasmapheresis, begins with a progressive increase in the number of platelets (86,000/mm3), as well as improvement in renal function (creatinine: 1.5 mg/24 h) and increased urine output (3000 c
Given the great clinical and analytical improvement, it was decided to continue with sessions of plasmapheresis every other day with progressive improvement in both renal function (have normalized [platelet creatinine: 115/25 mg/dl]) and platelet count: 24dl
Patient evolution is summarized in Figure 1.
1.
At present, the patient is clinically asymptomatic, normotensive and with normal laboratory parameters (renal function, hemoglobin and platelets).
