Atypical hemolytic uremic syndrome triggered by varicella infection

Abstract

Varicella Zoster Virus (VZV) is a well-known virus that belongs to the Herpesviridae family which induces a self-limited disease except in specific cases in particular among stem cell transplant patients. This virus is not known however to trigger atypical Hemolytic Uremic Syndrome (aHUS). Here we report the case of a six-year-old boy who was hospitalized with fever and abdominal pains associated to pruritic and vesicular rash, thrombocytopenia and acute renal failure. He was diagnosed with aHUS precipitated by varicella virus. He was treated by an association of antimicrobials against potential superinfections, plasmapheresis and eculizumab for curative aHUS treatment. This was effective but after 6 months the kidney function remained poor.The current case describes an aHUS associated to varicella infection as demonstrated by the simultaneous occurrence of the viral infection and aHUS manifestations. Apart from typical Hemolytic Uremic Syndrome which is triggered by bacteria mostly Shiga toxin producing Echerichia coli and Streptococcus pneumoniae or Shigella, aHUS may be linked to viral infections such as HIV, EBV and enteroviruses, but very rarely by varicella. This case highlights a possible even rare complication of varicella infection a very common childhood disease. This complication could be avoided by to anti-VZV vaccination.

End-Stage Kidney Disease Resulting from Atypical Hemolytic Uremic Syndrome after Receiving AstraZeneca SARS-CoV-2 Vaccine: A Case Report

“…Genetic or acquired dysregulation of the alternative complement pathway is highly implicated in the pathogenesis of aHUS [ 3 , 6 ]. In genetically susceptible individuals, many triggers have been linked to the development of aHUS, including pregnancy; transplantation; vaccination; and viral infections such as cytomegalovirus, Epstein–Barr virus, influenza, varicella, and Hepatitis B [ 4 , 10 , 11 , 12 ].…”

“…HUS is mainly a disease of children, with more than 90% of the cases typically occurring secondary to infection with Shiga-like toxin producing Escherichia coli (O157:H7 serotype) or other bacteria, such as Streptococcus pneumoniae and Shigella [ 1 , 2 ]. Atypical hemolytic uremic syndrome (aHUS) accounts for 5–10% of HUS cases, and it is named so because it is not caused by the typical HUS triggers [ 3 , 4 , 5 ]. Genetic or acquired dysregulation of the alternative complement proteins, particularly factors H, I, and B; membrane cofactor protein; and complement 3, is implicated in the pathogenesis of aHUS in 40–60% of the cases [ 6 ].…”

“…However, having prompt and definitive diagnosis is the key for successful treatment [ 7 , 8 , 9 ]. Many triggers for aHUS have been described in the literature, including pregnancy; transplantation; vaccination; and viral infections such as cytomegalovirus, Epstein–Barr virus, influenza, Varicella, and Hepatitis B, although no clear triggers are observed in 30% of aHUS cases [ 4 , 10 , 11 , 12 ]. Herein, we report a case of aHUS developed one a week following the administration of the first dose of AstraZeneca SARS-CoV-2 vaccine.…”

Virus-Associated Nephropathies: A Narrative Review

“…VZV infection involves the same complex of fusion proteins as other herpesviruses; however, it is more oriented toward cell-to-cell fusion than virus-to-cell fusion [ 153 ]. As for HSV, few cases have described the occurrence of nephropathy triggered by VZV infection; they mainly presented as glomerulonephritis [ 154 , 155 , 156 , 157 ], but also possibly as nephrotic syndrome [ 158 , 159 ] or thrombotic microangiopathy [ 160 ]. It should be noted that none of these studies demonstrated viral antigens in renal biopsies.…”