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M94A2936.TXT
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1994-10-25
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Document 2936
DOCN M94A2936
TI Refractory Eschericia coli 0157:H7 associated hemolytic uremic syndrome
(HUS) and HIV-infection.
DT 9412
AU Albrecht H; Stellbrink HJ; University of Hamburg, Germany.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):190 (abstract no. PB0187). Unique
Identifier : AIDSLINE ICA10/94369639
AB BACKGROUND: Thrombotic microangiopathies (TMA) are characterized by a
pentad of microangiopathic hemolytic anemia, thrombocytopenia, fever,
central nervous system abnormalities, and renal dysfunction. 2 distinct
forms of TMA exist: Thrombotic thrombocytopenic purpura (TTP),
characterized by minimal kidney dysfunction but severe neurological
impairment and HUS, usually without neurological abnormalitics.
Infection with E. coli producing a shiga-like toxin (most notably E.
coli 0157:H7) has been shown to be the major cause of HUS. The
association of TMA with HIV infection has been documented in more than
50 cases. Most cases are consistent with a diagnosis of TTP. E. coli
0157:H7 associated HUS, however, seems to be extremely rare with only
one reported case in the literature. We present a case of HUS caused by
E. coli 0157:H7 in an AIDS-patient, who was refractory to a variety of
therapeutic measures. CASE REPORT: A 33-year old white homosexual with
AIDS and a CD4 count of 20 cells/microliter was admitted because of
bloody diarrhea, fevers and intermittent nausea and vomiting. Lab.
values: LDH 1300 U/l, serum creatinine 2.3 mg/dl, BUN 51 mg/dl,
hemoglobin 9.1, WBC 2.55, platelets 24, Haptoglobin < 0.4 g/l. Bone
marrow cytology was normal. Urinalysis was positive for protein and
hemoglobin +. Multiple schistocytes were seen on blood smears. A stool
culture grew enterohemorrhagic escherichia coli (VTEC) which produced a
shiga-like toxin (SLK 2). Serotyping classified the VTEC as 0157:H7. The
patient was diagnosed with HUS. Despite vigorous treatment with
plasmapheresis, iv IgG, heparin, corticosteroids and vincristine
hemolysis never subsided and the patient died 3 months later.
DISCUSSION: Because anemia, thrombocytopenia, elevation of LDH, uremia,
and neurological abnormalities are not uncommon in HIV infected patients
and can be caused by many different diseases, TMAs may have been
overlooked in some patients reported in the literature despite a typical
presentation. Clinicians caring for patients with HIV infection must be
aware of the risk of TMAs in these patients and AIDS-patients with
bloody diarrhea should routinely be cultured for VTEC.
DE Adult AIDS-Related Opportunistic Infections/*DIAGNOSIS/PATHOLOGY/
THERAPY Bacterial Toxins/ANALYSIS Case Report Combined Modality
Therapy Escherichia coli/*CLASSIFICATION/PATHOGENICITY Escherichia
coli Infections/*DIAGNOSIS/PATHOLOGY/THERAPY Fatal Outcome
Hemolytic-Uremic Syndrome/*DIAGNOSIS/PATHOLOGY/THERAPY Homosexuality
Human HIV Infections/*DIAGNOSIS/PATHOLOGY/THERAPY Male Serotyping
MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).