Enteric Fever Causing Hemolytic Uremic Syndrome
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
- Bagha, Hussein Mohamed Afzal, M P Shah Hospital, Nairobi, Kenya
- Ahmed, Shamsa Hussein, M. P Shah Hospital, Nairobi, Kenya
- Twahir, Ahmed, Parkland Kidney Centre, Nairobi, Kenya
Hemolytic uremic syndrome presents with a classic triad of microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury. It is usually caused by toxigenic strains of Escherichia coli and Shigella dysenteriae. It can also be caused by Streptococcus pneumoniae and complement disorders. Typhoid fever causing hemolytic uremic syndrome is quite rare.
A fifty four year ol male with no known comorbids presented with a seven day history of diarrhea. He had been started on ciprofloxacin after a stool for salmonella antigen was found to be positive. He presented after seven days with worsening of diarrhea and one day history of vomiting. Examination revealed mild dehydration with normal vital signs and tenderness in the right and left iliac fossa regions. His laboratory investigations showed an elevated urea and creatinine with a low potassium. Blood cultures done on the day of admission grew Salmonella typhi which was sensitive to ciprofloxacin. The platelets and hemoglobin dropped on the second and third day after admission. The lactate dehydrogenase was markedly elevated and a peripheral blood film showed schistocytes. He was started on hemodialysis, intravenous antibiotics and potassium supplementation. After three sessions of dialysis his kidney function started improving and had complete recovery of his renal function.
Typical hemolytic uremic syndrome occurs secondary to infection by shiga-toxin producing E.coli and less frequently due to S.dysenteriae. It can also be caused by Streptococcus pneumoniae. Salmonella typhi is not a common cause of hemolytic uremic syndrome and there a few case reports in the literature of salmonella induced HUS. The inciting toxin in HUS due to Salmonella has not been identified. The treatment is mainly supportive comprising appropriate antibiotics, correcting fluid and electrolyte imbalances and timely dialysis. Most cases of acute kidney secondary to typical HUS are self limiting like in our case.