Isolated abducens nerve palsy treated by immunoadsorption in a patient with diarrhea-associated hemolytic uremic syndrome
Shiga toxin-producing Escherichia coli (STEC) that causes a prodromal hemorrhagic enteritis is the main cause of hemolytic uremic syndrome (HUS) particularly in pediatric patients. It is characterized by acute kidney injury with microangiopathic hemolytic anemia and thrombocytopenia. The kidney and...
| Main Authors: | , |
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| Format: | Article |
| Language: | Spanish |
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Asociación Regional de Diálisis y Trasplantes Renales de Capital Federal y Provincia de Buenos Aires
2018-07-01
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| Series: | Revista de Nefrología, Diálisis y Trasplante |
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| Online Access: | https://www.revistarenal.org.ar/index.php/rndt/article/view/313 |
| _version_ | 1819010424892293120 |
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| author | Sibel Ersan Sevda Uçkun Koçak |
| author_facet | Sibel Ersan Sevda Uçkun Koçak |
| author_sort | Sibel Ersan |
| collection | DOAJ |
| description | Shiga toxin-producing Escherichia coli (STEC) that causes a prodromal hemorrhagic enteritis is the main cause of hemolytic uremic syndrome (HUS) particularly in pediatric patients. It is characterized by acute kidney injury with microangiopathic hemolytic anemia and thrombocytopenia. The kidney and brain are the two major target organs, and neurological involvement is the most frequent cause of mortality. The time delay between bloody diarrhea and neurological symptoms ranges from few days to a month. Neurological disorders include disturbances in cognitive functions, focal neurological signs, epileptic seizures, myoclonus and neuropsychiatric symptoms. Cerebral magnetic resonance imaging reveals various patterns of hyperintensities distributed through cerebral matter or may be totally normal even the patient has severe neurological involvement. Electroencephalography usually show generalized or focal slowing of the background activity, spikes or sharp waves despite being normal in around 20% of patients.
We present here an adult male patient referred to our center with requirement of hemodialysis due to diarrhea-associated HUS complicated by acute kidney injury. Later during the course of plasma exchange therapy the patient developed an isolated abducens nerve palsy. Complete renal recovery was achieved by plasma exchange therapy but abducens palsy remedied rescue introduction of immunoglobulin G (IgG) depletion by immunoadsorption.
How to cite this article:
Ersan S, Koçak SU. Isolated abducens nerve palsy treated by immunoadsorption in a patient with diarrhea-associated hemolytic uremic syndrome. Rev Nefrol Dial Traspl. 2018; 38(2):134-8. |
| first_indexed | 2024-12-21T01:12:03Z |
| format | Article |
| id | doaj.art-3f94a4487bdd4b909d1e9103b00fb984 |
| institution | Directory Open Access Journal |
| issn | 0326-3428 2346-8548 |
| language | Spanish |
| last_indexed | 2024-12-21T01:12:03Z |
| publishDate | 2018-07-01 |
| publisher | Asociación Regional de Diálisis y Trasplantes Renales de Capital Federal y Provincia de Buenos Aires |
| record_format | Article |
| series | Revista de Nefrología, Diálisis y Trasplante |
| spelling | doaj.art-3f94a4487bdd4b909d1e9103b00fb9842022-12-21T19:20:54ZspaAsociación Regional de Diálisis y Trasplantes Renales de Capital Federal y Provincia de Buenos AiresRevista de Nefrología, Diálisis y Trasplante0326-34282346-85482018-07-01382134138295Isolated abducens nerve palsy treated by immunoadsorption in a patient with diarrhea-associated hemolytic uremic syndromeSibel Ersan0Sevda Uçkun Koçak1Department of Nephrology, Tepecik Research and Training Hospital, University of Health Sciences, İzmirInternal Medicine Department, Tepecik Research and Training Hospital, University of Health Sciences, İzmirShiga toxin-producing Escherichia coli (STEC) that causes a prodromal hemorrhagic enteritis is the main cause of hemolytic uremic syndrome (HUS) particularly in pediatric patients. It is characterized by acute kidney injury with microangiopathic hemolytic anemia and thrombocytopenia. The kidney and brain are the two major target organs, and neurological involvement is the most frequent cause of mortality. The time delay between bloody diarrhea and neurological symptoms ranges from few days to a month. Neurological disorders include disturbances in cognitive functions, focal neurological signs, epileptic seizures, myoclonus and neuropsychiatric symptoms. Cerebral magnetic resonance imaging reveals various patterns of hyperintensities distributed through cerebral matter or may be totally normal even the patient has severe neurological involvement. Electroencephalography usually show generalized or focal slowing of the background activity, spikes or sharp waves despite being normal in around 20% of patients. We present here an adult male patient referred to our center with requirement of hemodialysis due to diarrhea-associated HUS complicated by acute kidney injury. Later during the course of plasma exchange therapy the patient developed an isolated abducens nerve palsy. Complete renal recovery was achieved by plasma exchange therapy but abducens palsy remedied rescue introduction of immunoglobulin G (IgG) depletion by immunoadsorption. How to cite this article: Ersan S, Koçak SU. Isolated abducens nerve palsy treated by immunoadsorption in a patient with diarrhea-associated hemolytic uremic syndrome. Rev Nefrol Dial Traspl. 2018; 38(2):134-8.https://www.revistarenal.org.ar/index.php/rndt/article/view/313parálisis del nervio abducenssíndrome urémico hemolíticoinmunoadsorciónEscherichia colisíndrome neurológicotoxina Shiga |
| spellingShingle | Sibel Ersan Sevda Uçkun Koçak Isolated abducens nerve palsy treated by immunoadsorption in a patient with diarrhea-associated hemolytic uremic syndrome Revista de Nefrología, Diálisis y Trasplante parálisis del nervio abducens síndrome urémico hemolítico inmunoadsorción Escherichia coli síndrome neurológico toxina Shiga |
| title | Isolated abducens nerve palsy treated by immunoadsorption in a patient with diarrhea-associated hemolytic uremic syndrome |
| title_full | Isolated abducens nerve palsy treated by immunoadsorption in a patient with diarrhea-associated hemolytic uremic syndrome |
| title_fullStr | Isolated abducens nerve palsy treated by immunoadsorption in a patient with diarrhea-associated hemolytic uremic syndrome |
| title_full_unstemmed | Isolated abducens nerve palsy treated by immunoadsorption in a patient with diarrhea-associated hemolytic uremic syndrome |
| title_short | Isolated abducens nerve palsy treated by immunoadsorption in a patient with diarrhea-associated hemolytic uremic syndrome |
| title_sort | isolated abducens nerve palsy treated by immunoadsorption in a patient with diarrhea associated hemolytic uremic syndrome |
| topic | parálisis del nervio abducens síndrome urémico hemolítico inmunoadsorción Escherichia coli síndrome neurológico toxina Shiga |
| url | https://www.revistarenal.org.ar/index.php/rndt/article/view/313 |
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