Streptococcus pneumoniae-Associated Hemolytic Uremic Syndrome in a Splenectomized Adult Patient

Nobuki Maki, Atsushi Komatsuda, Hiroshi Ohtani, Jun Kuroki, Tamio Nishinari, Kenichi Asakura, Kenichi Sawada, Hideki Wakui
2012 Internal medicine (Tokyo. 1992)  
A 62-year-old splenectomized woman was admitted because of upper respiratory tract symptoms, general fatigue, and purpura. Laboratory data demonstrated microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure, and a positive Streptococcus pneumoniae (SP) urinary antigen test. A renal biopsy showed thrombotic microangiopathic changes. She was diagnosed with hemolytic uremic syndrome (HUS) secondary to SP infection. Methylprednisolone pulse therapy in addition to antibiotic
more » ... o antibiotic therapy led to prompt improvement of her symptoms and laboratory abnormalities. This is the first adult case of SP-associated HUS successfully treated without hemodialysis. SP infection should be considered as a causative etiology in all splenectomized patients with HUS. A 62-year-old woman was admitted because of general fatigue. At the age of 51, she was diagnosed with advanced gastric cancer, and underwent total gastrectomy with splenectomy. Around 1 week prior to admission, she developed upper respiratory tract symptoms, and was treated with nonsteroidal anti-inflammatory drug and antibiotic (cefcapene pivoxil hydrochloride). There was no diarrheal prodrome. On admission, her body temperature was 36.9 . A physical examination showed purpura on her face and legs, and mild pretibial edema. There were no abnormalities in the lungs, heart, and abdomen, except for surgical scars. Urinalysis showed proteinuria (1.0 g/g creatinine) and hematuria (red blood cells 20-29/high-power field). Urinary β2microglobulin was 41,770 μg/L. Fractional excretion of so-
doi:10.2169/internalmedicine.51.7916 pmid:22864126 fatcat:p3ep6vnzpjggzfb7nctjl4hcuu