Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literature
IntroductionAs the global pandemic continues, new complications of COVID-19 in pediatric population have turned up, one of them being hemolytic uremic syndrome (HUS), a complement-mediated thrombotic microangiopathy (CM-TMA) characterized by triad of thrombocytopenia, microangiopathic hemolytic anem...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-02-01
|
| Series: | Frontiers in Pediatrics |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1092860/full |
| _version_ | 1797924610488926208 |
|---|---|
| author | Matija Matošević Ivanka Kos Maša Davidović Maja Ban Hana Matković Ivan Jakopčić Ivana Vuković Brinar Ivana Vuković Brinar Ágnes Szilágyi Dorottya Csuka György Sinkovits Zoltán Prohászka Zoltán Prohászka Kristina Vrljičak Lovro Lamot Lovro Lamot |
| author_facet | Matija Matošević Ivanka Kos Maša Davidović Maja Ban Hana Matković Ivan Jakopčić Ivana Vuković Brinar Ivana Vuković Brinar Ágnes Szilágyi Dorottya Csuka György Sinkovits Zoltán Prohászka Zoltán Prohászka Kristina Vrljičak Lovro Lamot Lovro Lamot |
| author_sort | Matija Matošević |
| collection | DOAJ |
| description | IntroductionAs the global pandemic continues, new complications of COVID-19 in pediatric population have turned up, one of them being hemolytic uremic syndrome (HUS), a complement-mediated thrombotic microangiopathy (CM-TMA) characterized by triad of thrombocytopenia, microangiopathic hemolytic anemia and acute kidney injury (AKI). With both multisystem inflammatory syndrome in children (MIS-C) and HUS sharing complement dysregulation as one of the key factors, the aim of this case report is to highlight differences between these two conditions and also emphasize the importance of complement blockade as a treatment modality.Case reportWe describe a 21-month-old toddler who initially presented with fever and confirmed COVID-19. His condition quickly deteriorated and he developed oliguria, accompanied with diarrhea, vomiting and oral intake intolerance. HUS was suspected, supported with compelling laboratory findings, including decreased platelets count and C3 levels, elevated LDH, urea, serum creatinine and sC5b-9 and presence of schistocytes in peripheral blood, negative fecal Shiga toxin and normal ADAMTS13 metalloprotease activity. The patient was given C5 complement blocker Ravulizumab and started to display rapid improvement.ConclusionAlthough reports of HUS in the setting of COVID-19 continue to pour in, the questions of exact mechanism and similarities to MIS-C remain. Our case for the first time accentuates the use of complement blockade as a valuable treatment option in this scenario. We sincerely believe that reporting on HUS as a complication of COVID-19 in children will give rise to improved diagnosis and treatment, as well as better understanding of both of these intricating diseases. |
| first_indexed | 2024-04-10T15:04:44Z |
| format | Article |
| id | doaj.art-e7efc578371b4f5eb05cbe2fb4098080 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-10T15:04:44Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-e7efc578371b4f5eb05cbe2fb40980802023-02-15T08:41:39ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-02-011110.3389/fped.2023.10928601092860Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literatureMatija Matošević0Ivanka Kos1Maša Davidović2Maja Ban3Hana Matković4Ivan Jakopčić5Ivana Vuković Brinar6Ivana Vuković Brinar7Ágnes Szilágyi8Dorottya Csuka9György Sinkovits10Zoltán Prohászka11Zoltán Prohászka12Kristina Vrljičak13Lovro Lamot14Lovro Lamot15Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, CroatiaDivision of Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, CroatiaDivision of Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, CroatiaDivision of Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, CroatiaDivision of Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, CroatiaDivision of Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, CroatiaDepartment of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Zagreb, CroatiaDepartment of Internal Medicine and Haematology, Semmelweis University, Budapest, HungaryDepartment of Internal Medicine and Haematology, Semmelweis University, Budapest, HungaryDepartment of Internal Medicine and Haematology, Semmelweis University, Budapest, HungaryDepartment of Internal Medicine and Haematology, Semmelweis University, Budapest, HungaryDepartment of Internal Medicine and Haematology, Semmelweis University, Budapest, HungaryResearch Group for Immunology and Haematology, Semmelweis University- Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, HungaryDivision of Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, CroatiaDepartment of Pediatrics, University of Zagreb School of Medicine, Zagreb, CroatiaDivision of Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, CroatiaIntroductionAs the global pandemic continues, new complications of COVID-19 in pediatric population have turned up, one of them being hemolytic uremic syndrome (HUS), a complement-mediated thrombotic microangiopathy (CM-TMA) characterized by triad of thrombocytopenia, microangiopathic hemolytic anemia and acute kidney injury (AKI). With both multisystem inflammatory syndrome in children (MIS-C) and HUS sharing complement dysregulation as one of the key factors, the aim of this case report is to highlight differences between these two conditions and also emphasize the importance of complement blockade as a treatment modality.Case reportWe describe a 21-month-old toddler who initially presented with fever and confirmed COVID-19. His condition quickly deteriorated and he developed oliguria, accompanied with diarrhea, vomiting and oral intake intolerance. HUS was suspected, supported with compelling laboratory findings, including decreased platelets count and C3 levels, elevated LDH, urea, serum creatinine and sC5b-9 and presence of schistocytes in peripheral blood, negative fecal Shiga toxin and normal ADAMTS13 metalloprotease activity. The patient was given C5 complement blocker Ravulizumab and started to display rapid improvement.ConclusionAlthough reports of HUS in the setting of COVID-19 continue to pour in, the questions of exact mechanism and similarities to MIS-C remain. Our case for the first time accentuates the use of complement blockade as a valuable treatment option in this scenario. We sincerely believe that reporting on HUS as a complication of COVID-19 in children will give rise to improved diagnosis and treatment, as well as better understanding of both of these intricating diseases.https://www.frontiersin.org/articles/10.3389/fped.2023.1092860/fullhemolytic uremic syndromeHUSthrombotic microangiopathyTMACOVID-19complement blockade |
| spellingShingle | Matija Matošević Ivanka Kos Maša Davidović Maja Ban Hana Matković Ivan Jakopčić Ivana Vuković Brinar Ivana Vuković Brinar Ágnes Szilágyi Dorottya Csuka György Sinkovits Zoltán Prohászka Zoltán Prohászka Kristina Vrljičak Lovro Lamot Lovro Lamot Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literature Frontiers in Pediatrics hemolytic uremic syndrome HUS thrombotic microangiopathy TMA COVID-19 complement blockade |
| title | Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literature |
| title_full | Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literature |
| title_fullStr | Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literature |
| title_full_unstemmed | Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literature |
| title_short | Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literature |
| title_sort | hemolytic uremic syndrome in the setting of covid 19 successfully treated with complement inhibition therapy an instructive case report of a previously healthy toddler and review of literature |
| topic | hemolytic uremic syndrome HUS thrombotic microangiopathy TMA COVID-19 complement blockade |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1092860/full |
| work_keys_str_mv | AT matijamatosevic hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT ivankakos hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT masadavidovic hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT majaban hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT hanamatkovic hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT ivanjakopcic hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT ivanavukovicbrinar hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT ivanavukovicbrinar hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT agnesszilagyi hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT dorottyacsuka hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT gyorgysinkovits hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT zoltanprohaszka hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT zoltanprohaszka hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT kristinavrljicak hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT lovrolamot hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature AT lovrolamot hemolyticuremicsyndromeinthesettingofcovid19successfullytreatedwithcomplementinhibitiontherapyaninstructivecasereportofapreviouslyhealthytoddlerandreviewofliterature |