Acute Myeloid Leukemia as a Trigger for Hemolytic-Uremic Syndrome

Abstract

Acute myeloid leukemia (AML) has not been identified as a cause of secondary hemolytic-uremic syndrome (HUS). This case report describes a woman who developed severe HUS at the time of AML diagnosis and responded favorably to initial treatment with eculizumab, which stabilized her condition and allowed for treatment of the AML. After one year, with stable renal function and genetic studies reported as normal, eculizumab was successfully discontinued. The prompt use of eculizumab was critical to the patient's survival and improvement in renal function, highlighting the efficacy of early eculizumab treatment in secondary HUS.

Keywords: acute myeloid leukemia; eculizumab; hemolytic uremic syndrome.

Figure 1

Evolution of kidney function measured by plasma creatinine. The most important events and treatment received are reflected.

Figure 2

Pathological anatomy of the first renal biopsy with signs of TMA. Images (A,B) with hematoxylin and eosin and PAS staining: Interstitial fibrosis of 40% of the cortical tissue associated with tubular atrophy and a mild chronic inflammatory infiltrate. Images (C,D): Ectasia and capillary congestion, associated with focal mesangiolysis. Images (E,F) with Masson trichrome and silver staining: Highlight the ectasia and capillary congestion.