Forensic Science, Medicine, and Pathology

, Volume 13, Issue 2, pp 240–244 | Cite as

Hemolytic uremic syndrome caused by E. coli O157 infection

  • Philip V. Bystrom
  • Robert J. Beck
  • Joseph A. PrahlowEmail author
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Case report

A 7-year-old previously healthy boy presented with five days of low-grade fever, emesis, and bloody diarrhea. He was initially seen by his primary care physician where he was given a fluid bolus and was sent home. The patient returned to the hospital a few hours later because his symptoms had not improved and he had begun to feel lethargic. Upon admission he was noted to have persistent dehydration, hyponatremia, acute renal failure, leukocytosis with left shift, and an elevated C-reactive protein. The patient received a bolus of 5% dextrose in ½ normal saline. During his hospitalization the patient was noted to have multiple episodes of watery, bloody diarrhea as well as projectile emesis with dark black vomitus. No other family members were sick.

The patient was transferred from the community hospital to the pediatric intensive care unit of a tertiary care center for worsening hyponatremia and dehydration. The patient was neurologically intact (GCS 15) upon admission and...


Compliance with ethical standards

Conflict of interest

Authors PB, RB, and JP declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies/tests involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the parent(s) for all medical procedures described in this report, with the exception of the autopsy, which was performed under the jurisdiction of the medical examiner’s office. The informed consent included permission for specimen testing and record review for teaching and research purposes.


No sources of financial support.




  1. 1.
    Karch H, Tarr PI, Bielaszewska M. Enterohaemorrhagic Escherichia coli in human medicine. Int J Med Microbiol. 2005;295:405–18.CrossRefGoogle Scholar
  2. 2.
    Endo Y, Tsurugi K, Yutsudo T, Takeda Y, Ogasawara T, Igarashi K. Site of action of a Vero toxin (VT2) from Escherichia coli O157:H7 and of Shiga toxin on eukaryotic ribosomes. RNA N-glycosidase activity of the toxins. Eur J Biochem. 1988;171:45–50.CrossRefGoogle Scholar
  3. 3.
    Novicki TJ, Daly JA, Mottice SL, Carroll KC. Comparison of sorbitol MacConkey agar and a two-step method which utilizes enzyme-linked immunosorbent assay toxin testing and a chromogenic agar to detect and isolate enterohemorrhagic Escherichia coli. J Clin Microbiol. 2000;38:547–51.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Fratamico PM, Sackitey SK, Wiedmann M, Deng MY. Detection of Escherichia coli O157:H7 by multiplex PCR. J Clin Microbiol. 1995;33:2188–91.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Besser RE, Griffin PM. Escherichia coli o157:H7 gastroenteritis and the hemolytic uremic syndrome: an emerging infectious disease. Annu Rev Med. 1999;50:355–67.CrossRefGoogle Scholar
  6. 6.
    Proulx F, Seidman EG, Karpman D. Pathogenesis of Shiga toxin-associated hemolytic uremic syndrome. Pediatr Res. 2001;50:163–71.CrossRefGoogle Scholar
  7. 7.
    Kerr H, Richards A. Complement-mediated injury and protection of endothelium: lessons from atypical haemolytic uraemic syndrome. Immunobiology. 2012;217:195–203.CrossRefGoogle Scholar
  8. 8.
    Kumar V, Abbas A, Aster J. Robbins basic pathology. 9th ed. Philadelphia: Elsevier Saunders; 2013.Google Scholar
  9. 9.
    Wong CS, Jelacic S, Habeeb RL, Watkins SL, Tarr PI. The risk of the hemolytic–uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med. 2000;342:1930–6.CrossRefGoogle Scholar
  10. 10.
    Panos GZ, Betsi GI, Falagas ME. Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection? Aliment Pharmacol Ther. 2006;24:731–42.CrossRefGoogle Scholar
  11. 11.
    Lapeyraque AL, Malina M, Fremeaux-Bacchi V, Boppel T, Kirschfink M, Oualha M, et al. Eculizumab in severe Shiga-Toxin–Associated HUS. N Engl J Med. 2011;364:2561–3.CrossRefGoogle Scholar
  12. 12.
    Rother RP, Rollins SA, Mojcik CF, Brodsky RA, Bell L. Discovery and development of the complement inhibitor eculizumab for the treatment of paroxysmal nocturnal hemoglobinuria. Nat Biotechnol. 2007;25:1256–64.CrossRefGoogle Scholar
  13. 13.
    Schuller Y, Hollak CEM, Biegstraaten M. The quality of economic evaluations of ultra-orphan drugs in Europe - a systematic review. Orphanet J Rare Dis BioMed Central. 2015;10:92.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Philip V. Bystrom
    • 1
  • Robert J. Beck
    • 1
    • 2
  • Joseph A. Prahlow
    • 1
    Email author
  1. 1.Western Michigan University Homer Stryker M.D. School of MedicineKalamazooUSA
  2. 2.Bronson Methodist HospitalKalamazooUSA

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