Kidney Week

Abstract: FR-PO0484

Prolonged Disturbance of Consciousness Associated with Shiga Toxin-Producing Escherichia coli-Hemolytic Uremic Syndrome: A Case Report

Session Information

• AKI: Case Reports - TMA, Vasculitis, Immune-Mediated Injury, and Systemic Disease
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Noguchi, Yuji, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Yuji Noguchi, MD

• Toyohara, Takafumi, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Takafumi Toyohara, MD, PhD

• Kinomura, Sosuke, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Sosuke Kinomura, MD

• Kin, Saori, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Saori Kin, MD

• Kikuchi, Koichi, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Koichi Kikuchi, MD, PhD

• Makino, Rui, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Rui Makino, MD, PhD

• Yoshida, Mai, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Mai Yoshida

• Oe, Yuji, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Yuji Oe, MD, PhD

• Nagasawa, Tasuku, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Tasuku Nagasawa, MD, PhD

• Okamoto, Koji, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Koji Okamoto, MD, PhD

• Abe, Takaaki, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Takaaki Abe, MD, PhD

• Tanaka, Tetsuhiro, Tohoku Daigaku, Sendai, Miyagi Prefecture, Japan

Tetsuhiro Tanaka, MD, PhD, FASN

Introduction

Shiga toxin-producing Escherichia coli–associated hemolytic uremic syndrome (STEC-HUS) may cause severe encephalopathy with acute kidney injury, hemolytic anemia, and thrombocytopenia. Neurological symptoms usually improve within one month, and prolonged impaired consciousness is rare. We report a case of STEC-HUS encephalopathy with impaired consciousness lasting five months.

Case Description

A 21-year-old woman developed abdominal pain and diarrhea after eating cooked beef. Several days later, she developed loud crying and poor eye contact, and was taken to a local hospital. On day 10, she was diagnosed with thrombotic microangiopathy based on hemolytic anemia, thrombocytopenia, and acute kidney injury, and was transferred to our hospital. She received plasma exchange and immunoadsorption with corticosteroids. Subsequent verotoxin testing was positive, confirming STEC-HUS. After initiation of treatment, hematological abnormalities improved rapidly, allowing discontinuation of continuous hemodiafiltration by day 16 and withdrawal from mechanical ventilation by day 20. Although MRI findings improved by day 24 (Figure 1), impaired consciousness persisted, requiring hospitalization. Subsequently, her neurological status gradually improved, and by five months after onset, her Barthel Index increased from 0 to 100.

Discussion

Neurological involvement in STEC-HUS encephalopathy generally improves within one month, and prolonged impaired consciousness is uncommon. In this case, neurological impairment persisted for five months but eventually resolved. This discrepancy may reflect functional or microstructural injury beyond conventional MRI, possibly related to endothelial and microvascular dysfunction. This case suggests neurological recovery may occur even after prolonged impaired consciousness in STEC-HUS encephalopathy. Given the absence of established disease-specific therapy, management should include supportive care, rehabilitation, and long-term neurological follow-up, in addition to acute renal and hematological stabilization.

Figure 1. FLAIR MRI on day 10 showed bilateral external capsule hyperintensities, which improved on day 24.