Abstract
Hemolytic uremic syndrome (HUS) rarely occurs following Clostridium difficile infection (CDI). We report a case of HUS following CDI that was successfully treated with plasma exchange (PE). A 71-year-old woman was transferred to our hospital because of thrombocytopenia and renal dysfunction following CDI. Because she was diagnosed with disseminated intravascular coagulation caused by CDI, we started treatment with recombinant human thrombomodulin, antithrombin, and vancomycin. Continuous hemodiafiltration was also initiated to treat anuria. However, these interventions did not improve her thrombocytopenia or anuria, and she subsequently progressed to hemolytic anemia. Nine days after admission, she was diagnosed with thrombotic microangiopathy owing to hemolytic anemia, thrombocytopenia, and renal dysfunction. Therefore, PE was performed for 3 days. Thrombotic microangiopathy is a general term for HUS and thrombotic thrombocytopenic purpura. However, thrombocytopenic purpura was considered unlikely because a disintegrin-like and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS13) activity decreased slightly and specific antibodies to ADAMTS13 were not detected. Stool culture on admission was negative for Escherichia coli O157. Her anemia, thrombocytopenia, and renal dysfunction improved dramatically after 3 days of PE. Forty-two days after admission, she was discharged from the intensive care unit and she was transferred to an affiliated hospital without any sequelae.
