乙型流感引起的非典型溶血性尿毒症:病例报告。

HCA healthcare journal of medicine Pub Date : 2024-08-01 eCollection Date: 2024-01-01 DOI:10.36518/2689-0216.1669
Kathryn E McGraw, Amanda P Porter, Alyssa M Moffitt, Marina E M Golden, Heather Stewart
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引用次数: 0

摘要

背景:非典型溶血性尿毒症综合征(aHUS)是一种血栓性微血管病,表现为溶血性贫血、血小板减少和急性肾功能损害三联征。它可归因于一系列不同补体蛋白的突变导致补体系统过度激活,其中受影响最大的是替代途径。乙型流感虽然罕见,但已被证实是诱发甲型流感综合症的潜在因素:我们讨论的是一名有 aHUS 病史的 10 岁女孩,她在感染乙型流感后再次发生 aHUS。关于乙型流感引发 aHUS 的报道寥寥无几,因此这是一个独特的病例。鉴于该病例的复发和非典型特征,对其进行了基因检测,结果显示补体蛋白 CD46 存在杂合突变。CD46 基因突变是已知的 aHUS 易感因素,但 B 型流感感染很少被认为是 aHUS 的诱发因素。aHUS的预后各不相同,取决于个体特有的补体突变:结论:CD46基因突变的患者复发率高,但长期肾损害较小,本病例就是如此。临床医生应了解乙型流感与 aHUS 之间的关联,以改善患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Atypical Hemolytic Uremic Syndrome Following Influenza B: A Case Report.

Background: Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy that presents with a triad of hemolytic anemia, thrombocytopenia, and acute kidney impairment. It can be attributed to mutations in an array of different complement proteins leading to the overactivation of the complement system, the most impacted being the alternative pathway. Though rare, influenza B has been documented as a potential trigger to the development of aHUS.

Case presentation: We discuss a 10-year-old girl with a history of aHUS who was found to have a repeat episode of aHUS following an influenza B infection. There have only been a few reports of aHUS triggered by influenza B, making this a unique case. Given the recurrence and atypical features present in this case, a genetic workup was obtained, which showed a heterozygous mutation of complement protein CD46. The presence of mutations in CD46 is a known predisposing factor to aHUS, but influenza B infection is rarely implicated as a trigger to aHUS. The prognosis of aHUS varies and is dependent on the complement mutation specific to the individual.

Conclusion: Patients with CD46 mutations have been shown to have high rates of relapse but less long-term kidney damage, as seen in this case. Clinicians should be aware of the association between influenza B and aHUS to improve patient outcomes.

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