A diagnosis of haemolytic-uraemic syndrome blurred by alcohol abuse

Abstract

A 60-year-old man with a history of alcohol abuse was admitted to the intensive care unit (ICU) for status epilepticus. At first, laboratory and imagery findings were almost normal, and the symptoms were attributed to severe alcohol withdrawal due to a history of gastroenteritis reported by his family. But, during the following days, haemolytic anaemia, thrombocytopenia, acute renal failure, and ischaemic and haemorrhagic lesions seen on a cerebral CT scan led to the diagnosis of haemolytic-uraemic syndrome (HUS). Despite these severe complications, the patient made a good recovery following ICU and plasma exchange with fresh frozen plasma (FFP), but cognitive deficit still existed after 1 month. It is important to know that neurological manifestations can precede typical biological and radiological signs in HUS, and to not be misled in the diagnosis process, especially when a more common differential diagnosis is possible.

Figure 1

(A) Day 0: No cerebral lesion except for the known hydrocephaly and leukoaraiosis; (B) Day +7: Bilateral subarachnoid haemorrhage prominent in the bilateral occipitoparietal regions; (C) Day +11: Appearance of an ischaemic lesion in the left occipitoparietal region.

Figure 2

Specimens obtained after renal biopsy. (A) Periodic acid-Schiff stain showing osmotic nephrosis and a slightly abnormal glomerulus and (B) glomerular capillary wall thickening with double contours (arrowheads) revealed by silver impregnation and few fragmented red blood cells.