Streptococcus pneumoniae infection and hemolytic uremic syndrome.

Sr. Director: Recently it has published in Nefrologia a case of haemolytic uremic syndrome associated to pneumococcal infection (SP-HUS) in a 2-year-6-month old boy with pneumonia, that required veno-venous hemodiafiltration / hemofiltration during ten days. SP-HUS is an uncommon disease whose incidence, following invasive pneumococcal infection, is estimated at 0.4-0.6 %. Its mortality rate is high, also in recent series, when compared with cases secondary to Shiga-like toxic-producing E. Coli infection (STEC-HUS). Exposition of Thomsen–Friedenreich cryptantigen (TF) present on the surface of erythrocytes, platelets and glomerular endothelial cells, by pneumococcal neuraminidase seems to trigger clinical manifestations. Early recognition allows a proper treatment. Avoidance of plasma infusion and transfusions of unwashed blood products affects morbidity and mortality, as IgM-containing blood derivatives may increase cellular damage. We present a case of a 18-month old girl with high fever (40 °C) and te, recomendados en crisis renal es-clerodérmica. En ateroembolismos de colesterol se han utilizado recien-temente, observando resoluciones rá-pidas de la cianosis distal y del dolor en miembros inferiores, y mejorando la función renal 8-10. Por tanto, el tratamiento con iloprost podría considerarse una adecuada op-ción terapéutica de la EEC e instaurar-se de forma precoz por los beneficios que nos puede aportar en esta enferme-dad tan maligna. failure after invasive procedures. Natural history based on 52 histologically proven and prognosis of atheroembolic disease. patient under hemodialysis with acute distal ischaemia: cholesterol cristal embolism. Rev crystal embolism: a recognizable cause of disease. Supportive treatment improves survival in multivisceral cholesterol crystal embolism. Improvement in cholesterol emboli syndrome after iloprost therapy. cough for five days; she was admitted for right pneumonia with pleural effusion. She was anaemic (Hb 5.6 g/dL) with marked anisocytosis and schistocytosis and thrombocytopenic (30´10 9 /L). Fibrinogen levels, and prothrombin and partial thromboplastin times were normal, while a direct Coombs' test was positive. Creatinine was mildly increased (61 Ìmol/L) in presence of microhematuria and proteinuria. A rapid assay for detection of Streptococcus pneumoniae urinary antigen was positive. Subsequently Streptococcus Pneumoniae resulted from an hemoculture. Intravenous antibiotic therapy (ceftazidime + vancomycin) was administered. The patient was transferred into a paediatric nephrology department. Six days after admission a drainage of the persisting pleural effusion was performed. Four transfusions of washed irradiated red blood cells were necessary to correct the severe anaemia. Creatinine peaked at 79 Ìmol/L, to return quickly toward normal values; diuresis and blood pressure were always normal. No dialytic treatment was required. …