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Case Reports
. 2023 Feb 15:11:1092860.
doi: 10.3389/fped.2023.1092860. eCollection 2023.

Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literature

Matija Matošević  1 , Ivanka Kos  2 , Maša Davidović  2 , Maja Ban  2 , Hana Matković  2 , Ivan Jakopčić  2 , Ivana Vuković Brinar  3   4 , Ágnes Szilágyi  4 , Dorottya Csuka  4 , György Sinkovits  4 , Zoltán Prohászka  4   5 , Kristina Vrljičak  2 , Lovro Lamot  1   2
Affiliations
Case Reports

Hemolytic uremic syndrome in the setting of COVID-19 successfully treated with complement inhibition therapy: An instructive case report of a previously healthy toddler and review of literature

Matija Matošević et al. Front Pediatr. .

Abstract

Introduction: As the global pandemic continues, new complications of COVID-19 in pediatric population have turned up, one of them being hemolytic uremic syndrome (HUS), a complement-mediated thrombotic microangiopathy (CM-TMA) characterized by triad of thrombocytopenia, microangiopathic hemolytic anemia and acute kidney injury (AKI). With both multisystem inflammatory syndrome in children (MIS-C) and HUS sharing complement dysregulation as one of the key factors, the aim of this case report is to highlight differences between these two conditions and also emphasize the importance of complement blockade as a treatment modality.

Case report: We describe a 21-month-old toddler who initially presented with fever and confirmed COVID-19. His condition quickly deteriorated and he developed oliguria, accompanied with diarrhea, vomiting and oral intake intolerance. HUS was suspected, supported with compelling laboratory findings, including decreased platelets count and C3 levels, elevated LDH, urea, serum creatinine and sC5b-9 and presence of schistocytes in peripheral blood, negative fecal Shiga toxin and normal ADAMTS13 metalloprotease activity. The patient was given C5 complement blocker Ravulizumab and started to display rapid improvement.

Conclusion: Although reports of HUS in the setting of COVID-19 continue to pour in, the questions of exact mechanism and similarities to MIS-C remain. Our case for the first time accentuates the use of complement blockade as a valuable treatment option in this scenario. We sincerely believe that reporting on HUS as a complication of COVID-19 in children will give rise to improved diagnosis and treatment, as well as better understanding of both of these intricating diseases.

Keywords: COVID-19; HUS; TMA; complement blockade; hemolytic uremic syndrome; ravulizumab; thrombotic microangiopathy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Graphical representation of laboratory values and therapeutical interventions during the course of the disease. R, ravulizumab; TPE, therapeutic plasma exchange; RBC, red blood cells; PLT, platelets.
See this image and copyright information in PMC

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