Abstract: FR-PO0952
The Antibiotic Dilemma: Fatal Clostridium septicum Superinfection in a Child with Enteropathogenic Escherichia coli (EPEC)-Induced Hemolytic Uremic Syndrome
Session Information
- Pediatric Nephrology: Genetic Diseases, Development, Neonatal Nephrology, Glomerular Diseases, and More
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Kaplinsky, Nicole, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida, United States
- Rodriguez B, Estefania, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida, United States
Introduction
Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy classically caused by Shiga toxin-producing E coli (STEC). Antibiotic use in HUS during the diarrheal phase remains controversial due to concern for HUS progression. EPEC is a rare but recognized trigger of HUS. Clostridium septicum, an anaerobic gram-positive bacillus that can translocate from damaged intestinal mucosa, has been implicated in less than 50 pediatric cases. Of those reported, 10% had STEC-HUS as the underlying condition.
Case Description
We report a previously healthy 6-year-old female who presented with bloody diarrhea and abdominal pain. Workup revealed microangiopathic anemia (hemoglobin 8.7g/dL, schistocytes), thrombocytopenia, AKI (creatinine 3.94mg/dL), proteinuria, and gross hematuria consistent with HUS. Patient did not stool during admission so a sample was not available for evaluation. She was admitted to pediatric intensive care unit and started on continuous renal replacement therapy for worsening renal function. Antibiotics were deferred given concern for worsening HUS. On day 3, she developed persistent fever and leukocytosis (WBC 27,900/mcL). New right flank bruising prompted abdominal CT scan, which suggested an abscess of the right chest wall and subcutaneous edema. She deteriorated rapidly, suffered cardiac arrest, and died approximately 12 hours after fever onset. Autopsy confirmed EPEC on stool PCR and C. septicum in blood, CSF, chest cavity fluid, and respiratory specimens.
Discussion
The patient’s rapid decline and demise aligns with literature reports of HUS cases complicated by C. septicum septicemia. In the literature we reviewed on C. septicum septicemia, there were no survivors without antibiotics. This case highlights three critical teaching points: EPEC as an underrecognized HUS trigger, maintaining a high level of suspicion for C. septicum, and considering antibiotic initiation in patients beyond the diarrheal phase of illness who have aggressive disease. Clinicians managing pediatric HUS should recognize EPEC as a causative pathogen and maintain vigilance for C. septicum superinfection. The antibiotic controversy in HUS requires pathogen-specific nuance, a distinction this case tragically underscores.