title: Diarrhea-associated hemolytic uremic syndrome with severe neurological manifestations treated with IgG depletion through immunoadsorption.
abstract: BACKGROUND
  Diarrhea-associated hemolytic uremic syndrome (HUS) is characterized by acute kidney injury with microangiopathic hemolytic anemia and thrombocytopenia with a diarrhea prodrome, typically caused by Shiga-like toxin-producing Escherichia coli. Supportive management is generally recommended.
  
  
  METHODS
  A 58-year-old female with diarrhea-associated HUS developed delayed-onset severe neurological manifestations including coma, status epilepticus, and subcortical magnetic resonance imaging signal alterations. Rescue treatment with immunoglobulin (Ig)G depletion through immunoadsorption was followed by significant improvement in neurological and renal function. The patient recovered with only minimal sequelae.
  
  
  CONCLUSIONS
  Delayed-onset neurological abnormalities may occur in diarrhea-associated HUS. Novel specific treatment options include IgG depletion through immunoadsorption. Severe clinical and imaging findings do not preclude a good outcome.
authors.affiliation: Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, Solna, Stockholm, Sweden. benjamin.flam@karolinska.se.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Flam
authors.affiliation: Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, Solna, Stockholm, Sweden.|Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Sackey
authors.affiliation: Department of Infectious Disease, Karolinska University Hospital, Solna, Stockholm, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Berge
authors.affiliation: Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Zachau
authors.affiliation: Department of Nephrology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Brink
authors.affiliation: Department of Nephrology, Karolinska University Hospital, Stockholm, Sweden.|Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Lundberg
mesh_terms: D003128:Coma / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D003967:Diarrhea / Q000382:microbiology*; D004927:Escherichia coli Infections / Q000150:complications* / Q000382:microbiology; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000097:blood / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007163:Immunosorbent Techniques; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020127:Recovery of Function; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification*; D013226:Status Epilepticus / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D007074:Immunoglobulin G
keywords: Coma; Hemolytic-uremic syndrome; IgG depletion; Immunoadsorption; Shiga-toxigenic Escherichia coli; Status epilepticus