COVID-19 Mimicking Classic Hemolytic Syndrome in a Toddler

Le résumé fourni par la source

Introduction: Coronavirus disease 2019 (COVID-19) is a heterogenous, predominantly pulmonary disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thrombotic microangiopathy (TMA), a triad of hemolytic anemia, thrombocytopenia and end organ damage, is present in severe COVID-19 and Hemolytic uremic syndrome (HUS). Classic HUS is commonly caused by Shiga toxin (ST) producing Escherichia coli 0157:H7 (ST-HUS). We report a toddler with features of classic HUS with positive PCR testing for SARS-CoV-2. Case Description: A 2-year healthy girl presented with diarrhea of 7 days that turned bloody 2 days prior to admission. Previously, several family members with respiratory symptoms tested positive for COVID-19. On admission, she appeared jaundiced with generalized swelling, BP was 137/85 mm Hg (>99%). By day 2, her diarrhea subsided, she was oliguric, fatigued and listless. She was treated symptomatically and BP was controlled with labetalol. Pertinent laboratory data: Hemoglobin 5.1g/dL, reticulocyte 8.4%, platelets 51 K/μL lactate dehydrogenase 833 U/L and haptoglobin < 8 mg/dl. Serum creatinine (SCr) was 0.71 mg/dl with eGFR of 67 ml/min/1.73m2 and Urine showed +3 protein and blood. Random sample (RS) urine protein to Cr ratio was 5.1 (<0.2). Stool culture was negative for E. coli 0157:H7 and other enteropathogens. Shiga toxin 1 and 2 were negative by enzyme immune assay. Nasal swab was positive for SARS-CoV-2 by PCR. Genetic renal panel v8 for aHUS was negative. Complement, Coombs and ANA negative. ADAMSTS13 level >100%. By day 5, symptoms subsided and kidney function improved significantly with SCr at 0.55 mg/dl (eGFR 81ml/min/1.73m2). She was discharged on Lisinopril. Four months later, BP was 107/73 mm Hg and SCr 0.32 mg/dl (eGFR 127ml/min/1.73m2). Urine had trace protein with RS urine protein to Cr ratio of 0.32. Discussion: Both COVID-19 and HUS cause severe endothelial dysfunction resulting in release of inflammatory cytokines, complement dysregulation, and development of TMA. COVID-19 has been reported as a potential trigger of aHUS in patients with kidney involvement wherein genetic testing revealed complement defect. Our patient had features of classic HUS, was negative for ST-HUS and ST, but positive for SARS-CoV-2. COVID-19 may be considered in children with bloody diarrhea followed by hemolytic anemia, thrombocytopenia and acute kidney injury.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.