Exocrine pancreatic insufficiency in a child with STEC-HUS: a forgotten complication.

IF 2.6 3区医学 Q1 PEDIATRICS

Pediatric Nephrology Pub Date : 2025-02-01 Epub Date: 2024-09-09 DOI:10.1007/s00467-024-06513-3

Laura Beaudoin, Gisela Bambic, Irene Strasnoy, Laura García Chervo, Alejandro Balestracci

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Abstract

Background: Exocrine pancreatic insufficiency (EPI) is an extremely rare complication of hemolytic uremic syndrome related to Shiga toxin-producing Escherichia coli (STEC-HUS) and, to our knowledge, only one patient has been reported to have received pancreatic enzyme replacement therapy (PERT). Furthermore, STEC-HUS is not usually included among EPI causes.

Case diagnosis/treatment: We report a 4-year-old girl with STEC-HUS who required dialysis and 4 days after admission developed acute pancreatitis (ACPAN) and diabetes mellitus (DM). Amylase and lipase normalized 15 days later but on the 73rd day of admission, she presented abdominal discomfort, bloating, and bulky and malodorous stools with a low fecal elastase-1 level (FE-1) of 15.74 µg/g confirming EPI diagnosis. She received 3 months of PERT until normalization of FE-1 levels.

Conclusions: In children with STEC-HUS with ACPAN or DM, a high index of suspicion for EPI is required, since its symptoms are often mild, nonspecific, or delayed. In addition, STEC-HUS should be further recognized as a cause of secondary EPI.

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STEC-HUS 患儿的胰腺外分泌功能不全：一种被遗忘的并发症。

背景：胰腺外分泌功能不全（EPI）是与产志贺毒素大肠杆菌（STEC-HUS）相关的溶血性尿毒症综合征的一种极为罕见的并发症，据我们所知，仅有一名患者接受了胰酶替代疗法（PERT）。此外，STEC-HUS 通常不包括在 EPI 病因中：我们报告了一名患有 STEC-HUS 的 4 岁女孩，她需要进行透析，入院 4 天后出现急性胰腺炎（ACPAN）和糖尿病（DM）。15 天后，淀粉酶和脂肪酶恢复正常，但在入院第 73 天，她出现腹部不适、腹胀、大便粘稠和恶臭，粪便弹性蛋白酶-1（FE-1）水平低至 15.74 µg/g，确诊为 EPI。她接受了3个月的PERT治疗，直到FE-1水平恢复正常：结论：对于STEC-HUS合并ACPAN或DM的患儿，需要高度怀疑EPI，因为其症状通常轻微、非特异性或延迟。此外，还应进一步认识到 STEC-HUS 是继发性 EPI 的病因之一。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Nephrology 医学-泌尿学与肾脏学

CiteScore

4.70

自引率

20.00%

发文量

465

审稿时长

1 months

期刊介绍： International Pediatric Nephrology Association Pediatric Nephrology publishes original clinical research related to acute and chronic diseases that affect renal function, blood pressure, and fluid and electrolyte disorders in children. Studies may involve medical, surgical, nutritional, physiologic, biochemical, genetic, pathologic or immunologic aspects of disease, imaging techniques or consequences of acute or chronic kidney disease. There are 12 issues per year that contain Editorial Commentaries, Reviews, Educational Reviews, Original Articles, Brief Reports, Rapid Communications, Clinical Quizzes, and Letters to the Editors.