一例非典型溶血性尿毒症(aHUS)儿科病例:任何感染都可能是诱因吗?

Clinical nephrology. Case studies Pub Date : 2024-04-05 eCollection Date: 2024-01-01 DOI:10.5414/CNCS111209
Nikolaos Gkiourtzis, Paraskevi Panagopoulou, Kyriaki Papadopoulou-Legbelou, Sofia Chantavaridou, Despoina Tramma
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引用次数: 0

摘要

一名 12 岁男孩因发热、咳嗽和呕吐,伴有血小板减少、非免疫性溶血性贫血和急性肾损伤,从一家乡镇医院转入我院儿科,诊断为溶血性尿毒症综合征(HUS)。鼻咽拭子和下呼吸道样本经聚合酶链反应(PCR)检测出甲型流感。患者接受了奥司他韦和静脉输液治疗,并输入了新鲜冰冻血浆(FFP)。通过聚合酶链反应,在粪便样本中检测到肠道致病性大肠杆菌(EPEC)。血清中肺炎支原体(IgM 和 IgG)和幽门螺旋杆菌(IgA 和 IgG)抗体升高。进一步检查发现,血清 C5b-9 升高,提示同时存在病毒和细菌感染介导的补体过度激活,因此诊断为非典型 HUS(aHUS)。有文献报道非典型 HUS 与甲型流感有关,但 EPEC、肺炎支原体和幽门螺旋杆菌与非典型 HUS 的相关性尚未得到充分证实。患者共接受了 3 天的新鲜冰冻血浆治疗,随后临床和实验室指标均有所改善。直到出院后 5 个月的最近一次随访,患者仍无症状。本病例展示了不同病原体在 aHUS 发病机制中的潜在诱发作用,以提高儿科界的认识。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A pediatric case of atypical hemolytic uremic syndrome (aHUS): Could any infection play a triggering role?

A 12-year-old boy was transferred to our pediatric department from a rural hospital for fever, cough, and vomiting associated with thrombocytopenia, non-immune hemolytic anemia, and acute kidney injury, leading to the diagnosis of hemolytic uremic syndrome (HUS). A nasopharyngeal swab and a lower respiratory sample detected Influenza A by polymerase chain reaction (PCR). The patient was treated with oseltamivir and intravenous fluids in addition to fresh frozen plasma (FFP). Enteropathogenic Escherichia coli (EPEC) was detected in a stool sample by PCR. Serum antibodies for Mycoplasma pneumoniae (IgM and IgG) and Helicobacter pylori (IgA and IgG) were increased. Further work-up revealed elevated serum C5b-9 suggesting a simultaneous viral and bacterial infection-mediated complement overactivation leading to the diagnosis of atypical HUS (aHUS). An association between aHUS and influenza A is reported in the literature, but the correlation of EPEC, Mycoplasma pneumoniae, and Helicobacter pylori with aHUS is not well-established. Fresh frozen plasma was administered for a total of 3 days, followed by clinical and laboratory improvement. The patient has remained asymptomatic until the latest follow-up, 5 months after discharge. This case demonstrates the potential triggering role of different pathogens in aHUS pathogenesis to raise awareness in the pediatric community.

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