神经传染病

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Shiga Toxine Associates With Hemolytic Uremic Syndrome A Rare Cause Of Severe Neurological Involvement

Sidi Driss El Jaouhari, Najib Bouhabba, Zakaria El Hamdani, Hassan Baalal, Abdenasser El Kherrasse

Background: Hemolytic uremic syndrome is a microangiopathic hemolytic anemia discrabed as a clinical triad of acute kidney injury, hemolytic anemia and thrombocytopenia. The infectieuse etiology is most frequent, especially following contamination by Shiga toxin produced by Escherichia Coli. We présent the case of à patient with shiga toxin produced by Escherichia Coli presenting a multi-organ failure.

Case presentation : A 48-year-old man, presented no bloody diarrhea and abdominal pain 2 hours after eating a poorly preserved meat. Following the gradual worsening of clinical signs and the appearance of bloody diarrhea and respiratory distress, the patient was admitted in our hospital’s emergency department. Clinical examination reveals an apyretic, tachycard and polypneic patient. The pulmonary auscultation finds bilateral rousing rales. The initial laboratory test showed acute renal failure. Haemolytic anaemia was suspected in the presence of anaemia with elevated LDH and haptoglobin levels and thrombocytopenia. A thoraco-abdomino-pelvic Computed Tomography scan showed circumferential rectocolic thickening in favor of infectious colitis, acute lesional pulmonary edema and Balthazar stage C pancreatitis. Enterohemorrhagic Escherichia Coli producing Shiga toxin 2 was found in stool analysis. The most likely diagnosis was hemolytic uremic syndrome due to Shiga toxin producing Esherichia coli. On the eighth day, the patient presented a malignant hypertensive spike followed by bilateral blindness and then the appearance of generalised epileptic seizures. The patient mental statut worsened and he was died 20 days after onset symptoms.

Conclusion: Hemolytic uremic syndrome due to Shiga toxine producing by Esherichia Coli is a rare condition in adults. The prognosis depends on damage to vital organs, particularly the central nervous system. Improving the prognosis requires early diagnosis and replacement therapy for renal function or even plasmapheresis.