Pediatric Pneumococcal Hemolytic Uremic Syndrome Treated with Sequence Tandem Therapeutic Plasma Exchange and Continuous Venovenous Hemodiafiltration: A Case Report

Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Approximately 5% of HUS cases are associated with Streptococcus pneumoniae infections (pHUS). Treatment includes supportive care with appropriate antimicrobial therapy, fluid and blood product resuscitation, and renal replacement therapy. We presented a case of a 22-month-old previously healthy girl, who was hospitalized at University Hospital of Split. Left-sided pneumonia and sepsis caused by S. pneumoniae were confirmed. The course of illness was complicated with development of pHUS. Since the pathogenesis of pHUS is only partially understood, the treatment remains controversial. Our patient was successfully treated with daily sequence tandem continuous venovenous hemodiafiltration and therapeutic plasma exchange with albumins, along with other supportive measures. Therefore, in our opinion, plasmapheresis should be considered as a part of standard treatment of children with pHUS. Additionally, the incidence of pHUS appears to be increasing. S. pneumoniae is a particularly important among pediatric pathogens and it can cause wide spectrum of illnesses. Therefore, due to the significant burden of invasive pneumococcal disease, pneumococcal vaccination should be encouraged.