The clinical course of HUS is shown in Figure 2. Diarrhea, abdominal pain, fever, and vomiting develop a few days after inoculation with the pathogen. Within a week, the patient’s condition can either resolve or develop to full-blown HUS. HUS is defined by the classic triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury. Though the long-term prognosis for renal recovery is good, up to 50 percent of patients with HUS may require dialysis during the acute phase. Additionally, HUS can affect many other organ systems, including the central nervous system (CNS), gastrointestinal tract, liver, pancreas, and heart. CNS involvement, including seizures, coma, and stroke, is seen in up to 20 percent of cases and is associated with increased mortality.³ In this case, the patient was colonized with E. coli 0157 and had hematuria, rectal bleeding, hypotension due to significant fluid loss, and early renal injury. Early recognition and treatment resulted in a complete recovery.

Dr. Kwan is an emergency physician with Emergency Medical Management Associates and associate medical director at Garfield Medical Center in Monterey Park, California.

Ms. Kwan is a MS2 at Northwestern University Feinberg School of Medicine in Chicago.

References

1. Mayer CL, Leibowitz CS, Kurosawa S, et al. Shiga toxins and the pathophysiology of hemolytic uremic syndrome in humans and animals. Toxins (Basel). 2012;4(11):1261-1287.
2. Noris M, Remuzzi G. Hemolytic uremic syndrome. J Am Soc Nephrol. 2005;16(4):1035.
3. Nathanson S, Kwon T, Elmaleh M, et al. Acute neurological involvement in diarrhea-associated hemolytic uremic syndrome. Clin J Am Soc Nephrol. 2010;5(7):1218-1228.