title: Case Report: Severe form of hemolytic-uremic syndrome with multiple organ failure in a child: a case report.
abstract: BACKGROUND
  Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF).
  
  
  METHODS
  A previously healthy 4-year old Caucasian girl developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. By the end of the first week the diagnosis of the typical HUS was established. During the second week the disease progressed into MOF that included ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after one month of the disease. She was successfully treated in the intensive care unit and significant improvement was noticed after plasmapheresis and continuous veno-venous hemodialysis.
  
  
  CONCLUSIONS
  Early start of plasmapheresis and meticulous supportive treatment in the intensive care unit, including renal placement therapy, may be the therapy of choice in severe cases of HUS presented by MOF. Monitoring of prognostic factors is important for early performance of appropriate diagnostic and therapeutical interventions.
authors.affiliation: Department of Anesthesiology and Critical Care, University Hospital Rijeka, Rijeka, Croatia.
authors.forename: Dino
authors.initials: D
authors.lastname: Mijatovic
authors.affiliation: Department of Anesthesiology and Critical Care, University Hospital Rijeka, Rijeka, Croatia.
authors.forename: Ana
authors.initials: A
authors.lastname: Blagaic
authors.affiliation: Department of Anesthesiology and Critical Care, University Hospital Rijeka, Rijeka, Croatia.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Zupan
references.citation: J Pediatr Gastroenterol Nutr. 2004 Mar;38(3):352-4
references.pmid: 15076639
references.citation: Pediatr Nephrol. 2008 Oct;23(10):1749-60
references.pmid: 18704506
references.citation: J Am Soc Nephrol. 2005 Apr;16(4):1035-50
references.pmid: 15728781
references.citation: Pediatrics. 2006 May;117(5):1656-62
references.pmid: 16651320
references.citation: Hematology Am Soc Hematol Educ Program. 2012;2012:604-9
references.pmid: 23233641
references.citation: Pediatr Radiol. 2004 Oct;34(10):805-10
references.pmid: 15378218
references.citation: ScientificWorldJournal. 2007 Aug 10;7:1155-64
references.pmid: 17694250
references.citation: Ther Apher Dial. 2011 Feb;15(1):10-9
references.pmid: 21272247
references.citation: J Infect Dis. 2002 Aug 15;186(4):493-500
references.pmid: 12195376
references.citation: JAMA. 2003 Sep 10;290(10):1360-70
references.pmid: 12966129
references.citation: Clin J Am Soc Nephrol. 2010 Jul;5(7):1218-28
references.pmid: 20498239