P85 | Atypical presentation of an uncommon disease: a paradigmatic case
Year: 2025
Type: article
Study design: Case Report
Abstract: Case report: An 81-year-old woman came to our attention for hematic diarrhea, dehydration and postural instability. Laboratory findings showed anemia (Hb 8.9 g/dL), neutrophilic leukocytosis, thrombocytopenia (PLTs 80000/µL), acute renal injury (SCr 4.26 mg/dL), hyponatremia and elevated serum LDH (783 U/L). While in ER, she suffered from a single tonic-clonic seizure, which was treated with Diazepam. CT-scan and angiography of the head were negative for any findings; the EEG revealed widespread epileptiform abnormalities. Abdomen ultrasound ruled out a urinary tract obstruction. SCr levels remained stable despite infusion with NaCl 0.9%. Due to worsening of anemia (Hb 6.9 g/dL), the following additional tests were performed: D-dimer (22000 ng/mL), serum haptoglobin (low), total serum bilirubin (normal), complement C3 (normal), direct antiglobulin test (negative), and peripheral blood smear (schistocytes 4.2%). This data, combined with clinical features, lead us to suspect thrombotic microangiopathy. ADAMTS-13 activity (36%) ruled out thrombotic thrombocytopenic purpura. Contextually, a sample of urine cultures tested positive for E. coli and Shiga toxin was found in a stool sample, therefore the diagnosis of Shiga toxin-producing E. coli associated hemolytic uremic syndrome (STEC-HUS) was made. Conclusions: Intravenous fluids and antibiotic therapy were continued, leading to resolution of diarrhea and normalization of laboratory findings (at discharge Hb 9.3 g/dL, PLT 380000/µL, SCr 1.11 mg/dl). STEC-HUS, despite being typical of childhood, must always be considered in hospitalized complex patients.
Source: Italian Journal of Medicine
Authors: Vo Van Kha, Tran Thi Huong Ly, Pham Thi Thanh Hoa, Vo Huynh Nhu, Damas Hendriansyah, Nusratuddin Abdullah, Rudy B. Leonardy, Mardiah Tahir, Samrichard Rambulangi, Firdaus Hamid, Filomena Pietrantonio, Vera Kopsaj, Francesco Rosiello, Aurora Tomassoni, Luca Moriconi, Donatella Padua, Kiki Rizki Amelia, Efendi Lukas, Nurbani Bangsawan, Isharyah Sunarno, Retno Budiarti Farid, Sriwijaya Qadar, Rabab H. Elshaikh, Ashok Kumar Sah, Abdelrahman Mohamed Abukanna, Abdulrahman Algarni, Ammar Abdelmola, Hussam Ali Osman, Tagwa Yousif Elsayed Yousif, Elryah I. Ali, Hiba Ali, Ayman Hussein Alfeel, Thanh Long Nguyen, Victor Storm, Lam Toi Phung, Cong Thien Le, Thi Thu Ha Le, Thi Hoa Nguyen, Son Tung Vu, Thien Thang Tran, Minh Hanh Vu, Van Tuan Nguyen, Francesco Ventrella, Anna Belfiore, Antonio Greco, Franco Mastroianni, Salvatore Lenti, Domenico Ruggiero, Michele Cannone, Vincenzo Ostilio Palmieri, Massimo Errico, Giuseppe Mancia, Guido Grassi, Sverre E. Kjeldsen
Language: English
Subfield: Immunology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: diamond
OpenAlex ID: W4413687005