Hemolytic–Uremic Syndrome in a Grandmother

n the spring of 2007, just weeks before my college graduation , my parents called to tell me that my grandmother was sick. I was worried to hear that she was in the hospital, but like the rest of my family, I had little doubt that she'd be better in no time. At a spry 82 years, my grandmother was the picture of health. She was a nonsmoker, a nondrinker, and had had no medical problems except for mild asthma. A world traveler, avid gardener, and savvy businesswoman , she has been known to do her grocery shopping, attend a bank board meeting, talk her way out of a speeding ticket, and rearrange the living room furniture all in time to prepare dinner for 12 and cut fresh roses for the table. As a loving wife, mother of 5, and grandmother of 10, she is the family matriarch and holds us together in a way I never fully appreciated until that familiar structure was suddenly threatened. My grandmother's illness began with acute onset of abdominal cramps and watery, nonbloody diarrhea followed by nausea and vomiting. She had no fever. The diarrhea continued intermittently through the first day and night of her illness, and by the second day, when the diarrhea became grossly bloody, her internist had her admitted to a community hospital. At the time of admission, she was normotensive and still afebrile. Physical examination findings were unremark-able except for mild bilateral lower abdominal tenderness. The leukocyte count was mildly elevated at 13,500 cells/ μL, hemoglobin was within normal limits at 15.0 g/dL, and the platelet count was 263,000 cells/μL. Electrolytes were within normal limits, blood urea nitrogen was mildly elevated at 19 mg/dL, and creatinine was within normal limits at 0.7 mg/dL. Urinalysis findings were also within normal limits. A radiograph of her abdomen showed no signs of a perforated organ. Gastroenterologists were consulted. Their assessment suggested infectious diarrhea as the most likely diagnosis, followed by ischemic colitis and divertic-ular disease. To check for enteric infections, they ordered stool culture, stool leukocyte count, and a stool Clostridium difficile toxin test. Supportive treatment of intravenous hy-dration and antiemetics was initiated. On my grandmother's third day of illness, the bloody diarrhea worsened and the leukocyte count increased to 18,100 cells/μL. A stool sample contained no C. difficile toxin but did contain leukocytes. A contrast computed to-mography (CT) scan of the abdomen …