2017 Volume 8 Issue 1 Pages 76-79
An 18-year-old woman was admitted to an area hospital for abdominal pain, diarrhea, and fever, but her condition deteriorated, and she was transported to our hospital. The patient also had melena, hematuria, hemolytic anemia, thrombopenia, and an enterohemorrhagic Escherichia coli O157 infection. The diagnosis was hemolytic uremic syndrome （HUS）, and treatment centering on supportive therapy was initiated. Acute kidney injury developed on the 4th day in the hospital, and continuous blood purification therapy was introduced. On the 7th day in the hospital, the patient developed visual and auditory hallucinations, for which steroid semi-pulse therapy and plasma exchange were administered for 2 consecutive days. The hallucinations stopped, and her general condition rapidly improved. Continuous blood purification therapy was withdrawn on the 12th day in the hospital, and the patient was discharged with no renal or neurological sequela on the 25th day in the hospital. Shiga toxin and inflammatory cytokines are involved in the brain complications observed in HUS. Inhibition and removal of cytokines by both steroid semi-pulse therapy and blood purification may have a specific therapeutic effect. Since only a few adult cases of HUS complicated by encephalopathy have been reported, and the prognosis is poor, we report this case with the aim of establishing a treatment method in the future.
