Norovirus-associated hemolytic uremic syndrome. Case report
DOI:
https://doi.org/10.20453/rmh.v37i3.7158Keywords:
Norovirus, hemolytic uremic syndrome, acute kidney injury, microangiopathic hemolytic anemia, thrombocytopeniaAbstract
A 9-year-old female presented with watery diarrhea without mucus or blood, accompanied by signs of dehydration. Following intravenous fluid resuscitation, she developed palpebral and lower extremity edema. Laboratory evaluation revealed microangiopathic hemolytic anemia and thrombocytopenia associated with elevated blood urea and creatinine, leading to the diagnosis of typical hemolytic uremic syndrome (HUS), which required daily acute hemodialysis therapy. Testing for Shiga toxin was negative; however, a FilmArray PCR panel returned positive for norovirus. The patient demonstrated a favorable clinical course with recovery of diuresis and renal function. While this finding was incidental, only five cases have been reported worldwide to date, highlighting the importance of describing norovirus as a potential cause of HUS.
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References
Michael M, Bagga A, Sartain SE, Smith RJ. Haemolytic uraemic syndrome. Lancet. 2022;400(10364):1722-40. doi:10.1016/S0140-6736(22)01202-8
Sakihara G, Mansilla P, Valdivia V, Mendoza A, López V, Pimentel G, et al. Epidemiología y clínica del síndrome urémico hemolítico (SUH). Análisis de tres períodos de observación. Rev Peru Pediatr. 2012;65(3):111-21. doi:10.61651/rped.2012v65n3p111-121
Carrasco-Oros LV, Atamari-Anahui N, Goñi-Fano A, Sosa-Carmelo C, Guzmán-Quispe EJ, Conto-Palomino N, et al. Características del síndrome urémico hemolítico en pacientes de un hospital pediátrico de Perú, 2010-2020. Rev Peru Med Exp Salud Pública. 2023;40(2):207-12. doi:10.17843/rpmesp.2023.402.12708
Atamari-Anahui N, Cabello-Coca SE, Alvarado-Gamarra G, Apeña-Cabrera CL. Frecuencia de hospitalizaciones por síndrome urémico hemolítico en niños de 0 a 14 años en el Perú, periodo 2015 a 2022. An Fac Med. 2023;84(2):186-91. doi:10.15381/anales.v84i2.25083
Fakhouri F, Zuber J, Frémeaux-Bacchi V, Loirat C. Haemolytic uraemic syndrome. Lancet. 2017;390(10095):681-96. doi:10.1016/S0140-6736(17)30062-4. Erratum in: Lancet. 2017;390(10095):648. doi:10.1016/S0140-6736(17)31055-3
Yılmaz N, Yüksel S. Hemolytic uremic syndrome associated with norovirus gastroenteritis: case report and literature review. Nephron. 2022;146(5):489-93. doi:10.1159/000522497
Abu Daher G, Aoun B, Jaafar F, Khafaja S, Sanjad S. Norovirus: a novel etiologic agent in hemolytic uremic syndrome in an infant. BMC Nephrol. 2019;20(1):247. doi:10.1186/s12882-019-1427-6
Mansilla P. Características clínico-epidemiológicas de pacientes con diagnóstico de Síndrome Urémico Hemolítico hospitalizados en el Instituto Nacional de Salud del Niño entre el 2002 y el 2009. Rev Peru Pediatr. 2012;65(3):122-30. doi:10.61651/rped.2012v65n3p122-130
Lopes da Silva R. Viral-associated thrombotic microangiopathies. Hematol Oncol Stem Cell Ther. 2011;4(2):51-9. doi:10.5144/1658-3876.2011.51
Legendre CM, Licht C, Muus P, Greenbaum LA, Babu S, Bedrosian C, et al. Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome. N Engl J Med. 2013;368(23):2169-81. doi: 10.1056/NEJMoa1208981
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