Campylobacter-Associated Hemolytic Uremic Syndrome Associated with Pulmonary-Renal Syndrome

Abstract

Common causes of pulmonary-renal syndrome include anti-glomerular basement membrane (anti-GBM) disease anti-neutrophil cytoplasmic antibody (ANCA) positive vasculitis, and systemic lupus erythematosus. We describe a case of life-threatening pulmonary hemorrhage associated with Campylobacter hemolytic uremic syndrome (HUS), which we believe is a new disease entity. We hypothesize that the cause of this pulmonary-renal syndrome was an immunological reaction to Campylobacter; and that the initiation of high-dose steroids was responsible for the rapid reversal of the patient's pulmonary and renal impairment. The aim of this article is to raise awareness of this unusual cause of a pulmonary-renal syndrome, guiding physicians to recognize it as a potential complication, and to consider high-dose steroids in managing the condition.

Keywords: Campylobacter jejuni; hemolytic uremic syndrome; pulmonary hemorrhage.

Figure 1.

CT pulmonary angiogram showing bilateral ground glass opacities throughout both lungs and peri-bronchovascular consolidation mainly within the lower lobes bilaterally; consistent with pulmonary hemorrhage.

Figure 2.

a: Renal biopsy (haematoxylin and eosin stain) photomicrographs showing mesangiolytic changes and marked vascular changes with virtual obliteration of some arterioles. b: Silver stain showing double contours of the glomerular basement membrane, resembling a membrano-proliferative architecture.