Document 2936
 DOCN  M94A2936
 TI    Refractory Eschericia coli 0157:H7 associated hemolytic uremic syndrome
       (HUS) and HIV-infection.
 DT    9412
 AU    Albrecht H; Stellbrink HJ; University of Hamburg, Germany.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):190 (abstract no. PB0187). Unique
       Identifier : AIDSLINE ICA10/94369639
 AB    BACKGROUND: Thrombotic microangiopathies (TMA) are characterized by a
       pentad of microangiopathic hemolytic anemia, thrombocytopenia, fever,
       central nervous system abnormalities, and renal dysfunction. 2 distinct
       forms of TMA exist: Thrombotic thrombocytopenic purpura (TTP),
       characterized by minimal kidney dysfunction but severe neurological
       impairment and HUS, usually without neurological abnormalitics.
       Infection with E. coli producing a shiga-like toxin (most notably E.
       coli 0157:H7) has been shown to be the major cause of HUS. The
       association of TMA with HIV infection has been documented in more than
       50 cases. Most cases are consistent with a diagnosis of TTP. E. coli
       0157:H7 associated HUS, however, seems to be extremely rare with only
       one reported case in the literature. We present a case of HUS caused by
       E. coli 0157:H7 in an AIDS-patient, who was refractory to a variety of
       therapeutic measures. CASE REPORT: A 33-year old white homosexual with
       AIDS and a CD4 count of 20 cells/microliter was admitted because of
       bloody diarrhea, fevers and intermittent nausea and vomiting. Lab.
       values: LDH 1300 U/l, serum creatinine 2.3 mg/dl, BUN 51 mg/dl,
       hemoglobin 9.1, WBC 2.55, platelets 24, Haptoglobin < 0.4 g/l. Bone
       marrow cytology was normal. Urinalysis was positive for protein and
       hemoglobin +. Multiple schistocytes were seen on blood smears. A stool
       culture grew enterohemorrhagic escherichia coli (VTEC) which produced a
       shiga-like toxin (SLK 2). Serotyping classified the VTEC as 0157:H7. The
       patient was diagnosed with HUS. Despite vigorous treatment with
       plasmapheresis, iv IgG, heparin, corticosteroids and vincristine
       hemolysis never subsided and the patient died 3 months later.
       DISCUSSION: Because anemia, thrombocytopenia, elevation of LDH, uremia,
       and neurological abnormalities are not uncommon in HIV infected patients
       and can be caused by many different diseases, TMAs may have been
       overlooked in some patients reported in the literature despite a typical
       presentation. Clinicians caring for patients with HIV infection must be
       aware of the risk of TMAs in these patients and AIDS-patients with
       bloody diarrhea should routinely be cultured for VTEC.
 DE    Adult  AIDS-Related Opportunistic Infections/*DIAGNOSIS/PATHOLOGY/
       THERAPY  Bacterial Toxins/ANALYSIS  Case Report  Combined Modality
       Therapy  Escherichia coli/*CLASSIFICATION/PATHOGENICITY  Escherichia
       coli Infections/*DIAGNOSIS/PATHOLOGY/THERAPY  Fatal Outcome
       Hemolytic-Uremic Syndrome/*DIAGNOSIS/PATHOLOGY/THERAPY  Homosexuality
       Human  HIV Infections/*DIAGNOSIS/PATHOLOGY/THERAPY  Male  Serotyping
       MEETING ABSTRACT

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