Severe SARS-COV-2 infection in pediatric patient with atypical Hemolytic Uremic Syndrome: A case report

Hamza, Salih Boushra

doi:10.1016/j.amsu.2022.103400

Cited by 3 publications

(3 citation statements)

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“…Our literature research revealed nine case report-styled articles [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] comprising 15 pediatric cases of MAHA related to COVID-19 infections, of which six patients were diagnosed with TTP and nine patients were diagnosed with aHUS. Four out of six patients in TTP group were females, while six out of nine subjects in aHUS group were males.…”

Section: Resultsmentioning

confidence: 99%

“…Over the course of the pandemic, novel conditions and complications have surfaced, such as multisystem inflammatory syndrome in children (MIS-C), which frequently resembles other established diseases, such as thrombotic microangiopathy or Kawasaki disease [ 39 , 40 ]. Infection with this virus can lead to a wide range of clinical manifestations, including pediatric TMA, as shown by a growing number of clinical case reports [ 16 , 18 , 19 , 41 , 42 ]. Although still unclear, the mechanisms behind this association might be related to loss of protection of endothelial cells and thrombocytes against complement membrane attack complexes.…”

Section: Discussionmentioning

confidence: 99%

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Pitfalls of Thrombotic Microangiopathies in Children: Two Case Reports and Literature Review

et al. 2023

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Thrombotic microangiopathy can present itself in the form of several clinical entities, representing a real challenge for diagnosis and treatment in pediatric practice. Our article aims to explore the evolution of two rare cases of pediatric thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS) with extremely similar clinical pictures, which, coincidentally, presented at approximately the same time in our hospital. These cases and our literature review demonstrate the multiple facets of thrombotic microangiopathy, which can produce various determinations and salient manifestations even among the pediatric population. TTP and aHUS may represent genuine diagnostic pitfalls through the overlap of their clinical and biological findings, although they develop through fundamentally different mechanisms that require different therapeutic approaches. As a novelty, we underline that COVID-19 infection cannot be excluded as potential trigger for TTP and aHUS in our patients and we predict that other reports of such an association will follow, raising a complex question of COVID-19’s implication in the occurrence and evolution of thrombotic microangiopathies. On this matter, we conducted literature research that resulted in 15 cases of COVID-19 pediatric infections associated with either TTP or aHUS. Taking into consideration the morbidity associated with TTP and aHUS, an elaborate differential diagnosis and prompt intervention are of the essence.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pitfalls of Thrombotic Microangiopathies in Children: Two Case Reports and Literature Review

et al. 2023

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“…(Gülhan & Özaltın, 2021).Evidencia reciente ha demostrado que los pacientes con STEC-SHU que reciben transfusiones de plaquetas no presentan un aumento en los principales complicaciones, eventos trombóticos o mortalidad en comparación con los pacientes que no recibieron plaquetas. Sin embargo, la administración de plaquetas tampoco reduce las complicaciones hemorrágicas en esta población, por lo que se cuestiona el papel de la trasfusión plaquetaria como estrategia terapéutica (Manrique, et al, 2019) (Hamza, 2022). InmunoterapiaEn el SHUa y en el SHU-STEC con complicaciones graves neurológicas se aconseja el uso temprano del anticuerpo monoclonal anti C5 Eculizumab(Saborio, Durán, & Villalobos, 2019).El uso del plasma fresco congelado sigue siendo controversial, aun así, en los casos de SHUa en los que no se pueda iniciar con Eculizumab, podría ser útil la transfusión de plasma fresco congelado debido a su contenido de complemento, y su actividad removiendo los factores y anticuerpos mutados(Saborio, Durán, & Villalobos, 2019).Se ha propuesto el trasplante hepático para el SHUa causado por variantes genéticas en las proteínas del complemento sintetizadas en el hígado (CFH, CFI, FB y C3), sin embargo, es una técnica que ha mostrado alta tasa de mortalidad y morbilidad, que no se encuentra disponible en todos los centros de atención sanitaria(Avila, Cavero, & Cao, 2020).PlasmaféresisEn el síndrome hemolítico urémico al existir una falta del factor plasmático que estimula la prostaciclina (PGI2), esta disminución de la actividad de PGI2 permite la agregación plaquetaria e…”

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Síndrome hemolítico urémico en pacientes pediátricos, un artículo de revisión

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Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literature

et al. 2023

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IntroductionAs the global pandemic continues, new complications of COVID-19 in pediatric population have turned up, one of them being hemolytic uremic syndrome (HUS), a complement-mediated thrombotic microangiopathy (CM-TMA) characterized by triad of thrombocytopenia, microangiopathic hemolytic anemia and acute kidney injury (AKI). With both multisystem inflammatory syndrome in children (MIS-C) and HUS sharing complement dysregulation as one of the key factors, the aim of this case report is to highlight differences between these two conditions and also emphasize the importance of complement blockade as a treatment modality.Case reportWe describe a 21-month-old toddler who initially presented with fever and confirmed COVID-19. His condition quickly deteriorated and he developed oliguria, accompanied with diarrhea, vomiting and oral intake intolerance. HUS was suspected, supported with compelling laboratory findings, including decreased platelets count and C3 levels, elevated LDH, urea, serum creatinine and sC5b-9 and presence of schistocytes in peripheral blood, negative fecal Shiga toxin and normal ADAMTS13 metalloprotease activity. The patient was given C5 complement blocker Ravulizumab and started to display rapid improvement.ConclusionAlthough reports of HUS in the setting of COVID-19 continue to pour in, the questions of exact mechanism and similarities to MIS-C remain. Our case for the first time accentuates the use of complement blockade as a valuable treatment option in this scenario. We sincerely believe that reporting on HUS as a complication of COVID-19 in children will give rise to improved diagnosis and treatment, as well as better understanding of both of these intricating diseases.

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Severe SARS-COV-2 infection in pediatric patient with atypical Hemolytic Uremic Syndrome: A case report

Cited by 3 publications

References 13 publications

Pitfalls of Thrombotic Microangiopathies in Children: Two Case Reports and Literature Review

Pitfalls of Thrombotic Microangiopathies in Children: Two Case Reports and Literature Review

Síndrome hemolítico urémico en pacientes pediátricos, un artículo de revisión

Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literature

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