A case of hemolytic uremic syndrome associated with Epstein-Barr virus infection

Abstract

The precise etiology of hemolytic uremic syndrome (HUS) is unknown. However, it has been associated with bacterial (Shigella, Salmonella, E. coli, S. pneumoniae), Bartonella, and viral (coxsackie, ECHO, influenza, varicella. Epstein-Barr) infections and with endotoxemia. Recently, we experienced a case of HUS in a 16-year-old boy who was in the acute phase of an Epstein-Barr virus (EBV) infection. He had typical manifestations of HUS and EBV infection. He also transiently presented disseminated intravascular coagulation. His renal dysfunction recovered by supportive care, including hemodialysis, plasmapheresis, antihypertensive medication and aspirin. We present this case with a review of the literature as the second report of HUS associated with EBV infection.

Fig. 1.

The scarlatiniform skin rash in the 16-year-old boy with hemolytic uremic syndrome associated with Epstein-Barr virus infection. This rash appeared a few days before admission and subsided on the 3rd day after admission.

Fig. 2.

In the close-up of back, the petechial lesions were also observed. They also seem to be due to the Epstein-Barr virus infection.

Fig. 3.

The serum hemoglobin level, platelet count, blood urea nitrogen and creatinine before and after admission. Transfusion was done as follows: 4 units of packed RBCs 3 days before admission, 10 units of platelet concentrates and 2 units of fresh frozen plasma 2 days before admission and 2 units of packed RBCs on the 4th and on the 17th day after admission. H: hemodialysis; P: plasmapheresis using 10 units of fresh frozen plasma; T: transfusion; Hb: hemoglobin; BUN: blood urea nitrogen; Cr: creatinine.