title: Unexpected childhood death due to hemolytic uremic syndrome.
abstract: Two cases of unexpected childhood death due to hemolytic uremic syndrome are reported. A 21-month-old girl who was discovered dead in bed following a short illness was found at autopsy to have overwhelming sepsis resulting from transmural colitis. Escherichia coli serotype 0157A was isolated from the intestine, and renal changes of hemolytic uremic syndrome were found. A 4-year-old girl died suddenly in hospital from intracranial hemorrhage while being treated for hemolytic uremic syndrome-related renal failure. Culture of urine and feces grew verocytotoxin producing E. coli. These cases demonstrate that hemolytic uremic syndrome may be a rare cause of unexpected childhood death and that the diagnosis may not be established prior to autopsy. Postmortem culture of tissues and fluids in cases of suspected sepsis in children may be essential in establishing this diagnosis, because histologic evaluation may be compromised by profound sepsis and tissue putrefaction. Accuracy in diagnosis may have significant public health and medicolegal consequences.
authors.affiliation: Department of Histopathology, Women's and Children's Hospital, Adelaide, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Manton
authors.forename: N M
authors.initials: NM
authors.lastname: Smith
authors.forename: R W
authors.initials: RW
authors.lastname: Byard
mesh_terms: D001344:Autopsy; D016470:Bacteremia / Q000150:complications* / Q000209:etiology / Q000382:microbiology; D002544:Cerebral Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D002675:Child, Preschool; D003092:Colitis / Q000150:complications / Q000382:microbiology; D003645:Death, Sudden / Q000209:etiology*; D004927:Escherichia coli Infections / Q000150:complications* / Q000382:microbiology; D019453:Escherichia coli O157 / Q000302:isolation & purification*; D005260:Female; D005506:Food Contamination; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007223:Infant; D010538:Peritonitis / Q000150:complications / Q000382:microbiology; D011859:Radiography