title: Thomsen-Friedenreich antigen exposure as a cause of Streptococcus pyogenes-associated hemolytic-uremic syndrome.
abstract: Infection with Streptococcus pyogenes, a Group A beta-hemolytic streptococcus (GAS), is a rare cause of hemolyticuremic syndrome (HUS). Invasive infections with Streptococcus pneumoniae that produce neuraminidase are a well-recognized cause of HUS without diarrhea. The Thomsen- Friedenreich antigen (T antigen) plays a role in the pathophysiology of pneumococcal HUS. We describe the case of a 3-year-old boy with GAS-associated HUS and show how T-antigen exposure was implicated in this case. He had no diarrhea and cultures for blood, urine, and stool were negative. The urinary pneumococcal antigen was negative; his direct Coombs test was positive. Glomerular capillary loops, tubular epithelium on his renal biopsy specimen, and red blood cells in his blood smear showed positive fluorescence with anti-T lectin. Although the pathogenesis of GAS-associated HUS is not well understood, T-antigen exposure may be implicated in some cases with GAS-associated HUS.
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan. shimizum@staff.kanazawa-u.ac.jp
authors.forename: Masaki
authors.initials: M
authors.lastname: Shimizu
authors.forename: Tadafumi
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Natsuma
authors.initials: N
authors.lastname: Sakashita
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Ueno
authors.forename: Chisato
authors.initials: C
authors.lastname: Akita
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Ohta
authors.forename: Etsuko
authors.initials: E
authors.lastname: Kitano
authors.forename: Michiyo
authors.initials: M
authors.lastname: Hatanaka
authors.forename: Hajime
authors.initials: H
authors.lastname: Kitamura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saikawa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yachie
mesh_terms: D015295:Antigens, Tumor-Associated, Carbohydrate / Q000276:immunology*; D002675:Child, Preschool; D003176:Complement C3 / Q000032:analysis; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology*; D006801:Humans; D008297:Male; D013290:Streptococcal Infections / Q000150:complications*; D013297:Streptococcus pyogenes
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D003176:Complement C3; C016467:Thomsen-Friedenreich antigen