Posters
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Discipline Track
Community/Public Health
Abstract
Background: Hemolytic uremic syndrome (HUS) is a multisystem disease presenting as renal impairment, microangiopathic hemolytic anemia (MAHA) and thrombocytopenia with a peak incidence of 2.1 cases per 100,000 persons/year in general population.
Case Description: 81-year-old female with history of Diabetes, presented to us with non-bloody emesis and loose stools. Labs on admission were significant for WBC 17000, Hb 12.5, PLT 241, BUN 74, Cr 8.9 and Lactate 12. She was admitted for severe metabolic acidosis and acute renal failure attributed to metformin use and undifferentiated shock.
Patient developed acute worsening of respiratory status due to increasing acidosis requiring intubation. Bicarbonate infusion was started however patient had to undergo emergent dialysis for refractory acidosis. On 3rd day of admission patient developed dysentery which led to Hb drop to 7.1 and platelets to 96. Peripheral smear revealed thrombocytopenia and schistocytes. GI panel was positive for ETEC, EIEC, Shigella toxin producing E. coli (STEC) and Campylobacter. Diagnosis of STEC-HUS was made.
Patient was supportively managed with fluid resuscitation, pressors, antibiotics, hemodialysis and transfusions. She demonstrated significant improvement, attained hemodynamical stability off pressors and was eventually extubated. Patient was discharged few days later at her baseline health.
Conclusion: It is challenging to diagnose STEC-HUS in older patients as the prevalence is higher in children and adults present with higher hemoglobin and fibrinogen levels. However, we emphasize on considering it as a differential diagnosis especially in elderly presenting with acute renal failure and history of gastroenteritis.
Presentation Type
Poster
Recommended Citation
Khan, Nazish; Chacko, Ashika A.; Kolli, Himabindu; and Varghese, Nevin A., "STEC-HUS; Unusual presentation in an elderly female" (2023). Research Colloquium. 56.
https://scholarworks.utrgv.edu/colloquium/presentation/poster/56
Included in
STEC-HUS; Unusual presentation in an elderly female
Background: Hemolytic uremic syndrome (HUS) is a multisystem disease presenting as renal impairment, microangiopathic hemolytic anemia (MAHA) and thrombocytopenia with a peak incidence of 2.1 cases per 100,000 persons/year in general population.
Case Description: 81-year-old female with history of Diabetes, presented to us with non-bloody emesis and loose stools. Labs on admission were significant for WBC 17000, Hb 12.5, PLT 241, BUN 74, Cr 8.9 and Lactate 12. She was admitted for severe metabolic acidosis and acute renal failure attributed to metformin use and undifferentiated shock.
Patient developed acute worsening of respiratory status due to increasing acidosis requiring intubation. Bicarbonate infusion was started however patient had to undergo emergent dialysis for refractory acidosis. On 3rd day of admission patient developed dysentery which led to Hb drop to 7.1 and platelets to 96. Peripheral smear revealed thrombocytopenia and schistocytes. GI panel was positive for ETEC, EIEC, Shigella toxin producing E. coli (STEC) and Campylobacter. Diagnosis of STEC-HUS was made.
Patient was supportively managed with fluid resuscitation, pressors, antibiotics, hemodialysis and transfusions. She demonstrated significant improvement, attained hemodynamical stability off pressors and was eventually extubated. Patient was discharged few days later at her baseline health.
Conclusion: It is challenging to diagnose STEC-HUS in older patients as the prevalence is higher in children and adults present with higher hemoglobin and fibrinogen levels. However, we emphasize on considering it as a differential diagnosis especially in elderly presenting with acute renal failure and history of gastroenteritis.