Severe pneumococcal hemolytic uremic syndrome in an 8-month-old girl

The hemolytic uremic syndrome (HUS),characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure,represents one of the major causes of acute renal failure in infancy and childhood. The typical form occurring after an episode of diarrhea caused by Escherichia coli is the most frequent in children. Other microorganisms also may be responsible for HUS,such as Streptococcus pneumoniae,which causes more severe forms of the disease. We report an 8-month-old girl who presented with pneumonia and subsequently developed HUS. Renal biopsy showed characteristic lesion of thrombotic microangiopathy and extensive cortical necrosis. She was managed with peritoneal dialysis but did not improve and developed severe sepsis due to staphylococcal peritonitis,resulting in the death of the patient. Streptococcus pneumoniae-induced HUS is uncommon,but results in severe disease in the young. There is a high risk of these patients developing end-stage kidney disease in the long term.