Presence of oligouria is an independent risk factor for mortality [ 2 ]. In our case, a management dilemma was faced, as there was a clear indication for PEX but the potential of serious complications associated with PEX in probable underlying infection was also taken into consideration. Immunological studies for antinuclear and antineutrophil cytoplasmic antibodies were negative. While eculizumab is being used to treat atypical hemolytic uremic syndrome, no evidence as of supports its use in the main forms of HUS. N Engl J Med. The main lesion seen in leptospira infection is tubulointerstitial nephritis with sparse lymphocytic infiltrates, tubular necrosis and interstitial oedema [ 2 , 7 ]. Most of the published literatures are from Asia.

After eating contaminated food, the first symptoms of infection can emerge anywhere from 1 to 10 days later, but usually after 3 to 4 days. The Shiga-toxin-activated endothelial cells then become thrombogenic clot-producing by a mechanism that is not fully understood, [35] though they have been shown to induce the release of cytokines and chemokines that are implicated in platelet activation. Incidence of epileptic syndromes. C3 level was normal but C4 level was reduced at 0. Megaloblastic anemia Pernicious anemia. In light of his history of diarrhoea, acute kidney injury, and thrombocytopenia with evidence of haemolysis, a presumptive diagnosis of shiga toxin-producing Escherichia coli induced haemolytic uraemic syndrome HUS was made. Hemolytic-uremic syndrome Synonyms Haemolytic-uraemic syndrome, thrombocytopenia and microangiopathic hemolytic anemia associated with distorted erythrocytes Schistocytes as seen in a person with hemolytic-uremic syndrome Specialty Pediatrics , nephrology Symptoms Low platelets , low red blood cells , and kidney failure following a few days of bloody diarrhea [1] Complications Neurological problems , heart failure [1] Types Shiga toxin—producing E. AKI due to leptospirosis is common in tropical countries but remains a rare cause of AKI in western countries.

Competing interests The authors declare that there is no competing interest. Typical manifestations of leptospirosis fall into four categories: The neurological syndrome in adults during the northern German E. The status epilepticus was difficult to treat, possibly because haemolyti the presence of subarachnoid haemorrhage in addition to HUS itself, but it eventually ceased and sedation was stopped.

Two weeks after successful extubation, renal and haematological conditions were back to normal, neurological deficits improved but phasic and cognitive impairments still existed, and the patient was admitted to the hospital rehabilitation service. The arterioles and capillaries of the body become obstructed by the resulting complexes of activated plateletswhich have adhered to the endothelium via large multimeric vWF. N Engl J Med ; Acknowledgements Not applicable Funding None.


Take a look at our subscription options. Typically release haemolyytic endotoxins associated with the death of these bacteria occurs faster than the removal of the toxins by body [ 13 ].

Hemolytic-uremic syndrome

A diagnosis of bpood uraemic syndrome was made. Fanconi anemia Diamond—Blackfan anemia Acquired: In our case, the persistence of neurological sequelae dysphasia, cognitive impairment could be explained by the probable presence of thrombotic microangiopathy lesions, in view of the CT findings.

Effectiveness of therapeutic plasma exchange in the Lanarkshire Escherichia coli O Diagnostic work-up supports the differential diagnosis of TMA-causing diseases. The first CT in the ER revealed no relevant cerebral abnormality and lumbar puncture showed no sign of meningitis.

A diagnosis of haemolytic-uraemic syndrome blurred by alcohol abuse

BT had the idea for the article, contributed blold the literature search and drafted and revised the paper. Leptospirosis is a rare infectious disease especially in Western Countries. D ICD – C3 level was normal but C4 level was reduced at 0. Glucosephosphate dehydrogenase deficiency glycolysis pyruvate kinase deficiency triosephosphate isomerase deficiency hexokinase deficiency hemoglobinopathy: Hemolytic uremic syndrome in leptospirosis bataviae.

Leptospirosis presenting as haemolytic uraemic syndrome: a case report

syndrkme Hemolytic-uremic syndrome HUS is a group of blood disorders characterized by low red blood cellsacute kidney failureand low platelets. It has been described that in addition to inflicting severe microvascular damage, Shiga toxin on its own evokes a strong neuronal membrane depolarisation, calcium accumulation and thalamic apoptosis.

Availability of data and materials Not applicable. HUS has been reported in Leptospira bataviae infection [ 12 ]. The differential diagnosis of atypical HUS, haemolhtic is a rare form of thrombotic microangiopathy frequently associated with genetic or acquired disorders leading to dysregulation of the alternative pathway of complement, was considered, but normal C3 and factor B levels, our patient’s age and the absence of relapse after a 6-month follow-up made it less probable.

Case Report: A diagnosis of haemolytic-uraemic syndrome blurred by alcohol abuse

Support Center Support Center. Renal involvement in leptospirosis is frequent and ranges from subtle changes with urinary sediment to acute kidney injury AKI. Retrieved 22 November Received Oct 28; Accepted Jan Differential diagnosis Initially, before the presence of classical thrombotic microangiopathy signs, the patient’s neurological symptoms and biological abnormalities were attributed to an association of more common conditions.


Retrieved from ” https: Blood tests, stool tests [3]. World Journal of Nephrology. Initially, before the presence of classical thrombotic microangiopathy signs, the patient’s neurological symptoms and biological abnormalities were attributed to an association of more common conditions.

Ueaemic, the stool culture was negative which led to a suspicion of leptospirosis as one of the differential diagnoses. Syndromd Warm autoimmune hemolytic anemia Cold agglutinin disease Paroxysmal cold hemoglobinuria membrane paroxysmal nocturnal hemoglobinuria Microangiopathic hemolytic anemia Thrombotic microangiopathy Hemolytic-uremic syndrome Drug-induced autoimmune Drug-induced nonautoimmune Hemolytic disease of the newborn.

Your feedback has been submitted successfully. In May, an epidemic of bloody diarrhea caused by E.

Epilepsia ; 49 Suppl 1: Assuming our patient had one of these common conditions that can lead to seizures and which are related to alcohol abuse or its withdrawal, we misdiagnosed this case, despite the progressive appearance of biological symptoms pointing at a differential diagnosis.

At first, laboratory and imagery findings were almost normal, and the symptoms were attributed to severe alcohol withdrawal due to a history of gastroenteritis reported by his family.

The typical pathophysiology of HUS involves the binding of Shiga-toxin to the globotriaosylceramide Gb3; also called ceramide trihexoside which accumulates in Fabry disease receptor on the surface of the glomerular endothelium. In our case, these misleading symptoms were present and, also, seizures started prior to classic biological abnormalities.

Rickettsia rickettsii Rocky Mountain spotted fever Rickettsia conorii Boutonneuse fever Rickettsia japonica Japanese spotted fever Rickettsia sibirica North Asian tick typhus Rickettsia australis Queensland tick typhus Rickettsia honei Flinders Island spotted fever Rickettsia africae African tick bite fever Rickettsia parkeri American tick bite fever Rickettsia aeschlimannii Rickettsia aeschlimannii infection.

Acute renal failure in a patient with both Leptospirosis and dengue fever. World J Pharm Res. Mark John Blunden, Email: