Atypical hemolytic uremic syndrome (aHUS), defines as non-Shiga toxin HUS, is thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, consumptive thrombocytopenia, and renal impairment. aHUS is associated with high morbidity and mortality, necessitating the need for an early diagnosis to limit target organ damage. Mutations or autoantibodies against specific complement factors over-activate the complement system forming microthrombi. aHUS has the potential to cause multi-organ system dysfunction, but it predominantly affects the kidneys. aHUS is treated with eculizumab, a terminal blocker of the complement system. Clostridium difficile infection is a rare precipitant of aHUS. We present a case of aHUS associated with Clostridium difficile infection in a 60-year-old female patient that was successfully treated with eculizumab.

The hyperglycemic hyperosmolar state (HHS) is a serious acute complication of type 2 diabetes mellitus that requires prompt recognition, diagnosis, and treatment. Reversible acute kidney injury is common in hyperglycemic states. However, hyperglycemic emergencies can contribute to the development of rhabdomyolysis, which can further aggravate acute kidney injury and can cause high morbidity and mortality. HHS can be the first clinical presentation of diabetes mellitus in some patients. Here, we present a case of HHS-related rhabdomyolysis and acute kidney injury, which was the first presentation of type 2 diabetes mellitus in this patient. Our case highlights the importance of a rare association between rhabdomyolysis and HHS in diabetic patients.