Published online Feb 14, 2018. doi: 10.3748/wjg.v24.i6.763
Peer-review started: November 17, 2017
First decision: December 13, 2017
Revised: December 15, 2017
Accepted: December 20, 2017
Article in press: December 20, 2017
Published online: February 14, 2018
Processing time: 81 Days and 4.2 Hours
A 61-year-old woman, with hypertension, osteoarthritis and irritable bowel syndrome, presented to emergency department after 5 d of bloody diarrhea without mucus.
The diagnosis of hemolytic uremic syndrome (HUS) was based on the presence of diarrheal prodrome, thrombocytopenia and the development of acute renal failure.
Thrombotic thrombocytic purpura and other causes of thrombocytopenia.
Moderate hydroelectrolytic disequilibrium, thrombocytopenia and microangiopathic hemolytic anemia.
The culture showed the presence of E. coli producing extended-spectrum β-lactamases.
Fluid and electrolyte replacement, plasma exchange, hemodialysis and intravenous antibiotic therapy with ertapenem.
HUS associated to gastroenteritis is a rare event in adults due to very few cases had been detected. However, this disorder has high mortality but good prognosis when it is diagnosed in early stages. The treatment should be based on syndromic approach according to guidelines.
ADAMTS13 - a disintegrin-like metalloproteinase with thrombospondin motif type 1 member 13 - cleaves Von Willebrand factor anchored on the endothelial surface, in circulation, and at the sites of vascular injury.
The gastroenterologist may encounter the HUS as it presents with primarily intestinal symptoms or may assist in the management of the abdominal complications. Anticipation of the broad clinical scope of the HUS is essential for the optimal management of this serious entity.