Abstract
Background
Atypical haemolytic uraemic syndrome (aHUS) is a rare disorder usually caused by dysregulation of the alternative complement pathway. Uncontrolled complement activation results in systemic complement-mediated thrombotic microangiopathy (TMA) and subsequent multi-organ damage. The two most common extrarenal complications comprise neurological and cardiovascular involvement. Eculizumab, a humanised anti-C5 monoclonal antibody, has recently been introduced as a therapy for this condition.
Case-diagnosis/treatment
A 19-month-old child suffering from aHUS with severe neurological involvement, dilated cardiomyopathy and renal impairment requiring dialysis received eculizumab as first-line treatment, initiated within 12 h of admission, resulting in significant improvements in her neurological state and normalisation of cardiac and renal function. These positive outcomes have been sustained with fortnightly eculizumab therapy (at the time of writing, on-going for 1 year). No further complications of TMA have occurred.
Conclusion
Severe cardiac involvement in a child with aHUS is an important indication for prompt, first-line treatment with eculizumab, resulting in rapid normalisation of cardiac function.
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Acknowledgements
We thank Lisa Strain and Louise Stanley of the Northern Molecular Genetics Laboratory, Newcastle-upon-Tyne, for the gene sequencing.
Conflict of interest
R.D. Gilbert has received honoraria for speaking at meetings sponsored by Alexion. A. Nagra, M. R. Haq and R. D. Gilbert have attended conferences with financial assistance from Alexion.
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Hu, H., Nagra, A., Haq, M.R. et al. Eculizumab in atypical haemolytic uraemic syndrome with severe cardiac and neurological involvement. Pediatr Nephrol 29, 1103–1106 (2014). https://doi.org/10.1007/s00467-013-2709-z
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DOI: https://doi.org/10.1007/s00467-013-2709-z