Tohoku J. Exp. Med., 2001, 193 (1)

Case Report

Thrombotic Stroke in a Child with Diarrhea-Associated Hemolytic-Uremic Syndrome with a Good Recovery

TOHRU NAKAHATA, HIROSHI TANAKA, TAKASHI TATEYAMA, TOMOMI UEDA, KOICHI SUZUKI, SHIN-ICHI OSARI,¹ MIKIO KASAI¹ and SHINOBU WAGA

Department of Pediatrics, Hirosaki University School of Medicine,
Hirosaki 036-8562 and
¹Division of Pediatrics, Hirosaki Municipal Hospital, Hirosaki 036-8182

A boy aged 3.5 years with post-diarrheal hemolytic-uremic syndrome (HUS) was referred to our hospital because of convulsion and stupor. He had been admitted to a regional hospital with a 3-day history of bloody diarrhea, colic abdominal pain and fever. Two days later, he had complained of generalized seizures and oliguria. On admission, he developed anuria, and serum blood nitrogen and creatinine increased to 56 mg/100 ml and 2.8 mg/100 ml, respectively. Platelets decreased to 42 000/ml. Under the diagnosis of HUS, a continuous hemodiafiltration treatment had to be instituted. Computed tomography of his head at hospital day 5 revealed abnormal low density area of infarction with edema in both the basal ganglia involving with the posterior limb of internal capsule. Serum titer of IgM antibody to Escherichia coli O157 showed positive value. Although his anuria and stupor persisted over 10 days, he recovered without serious complications. These clinical observations may indicate that patients with similar lesions do not necessarily have serious morbidity.

Keywords —— central nervous system involvement; continuous hemodiafiltration; favorable outcome; hemolytic-uremic syndrome; stroke

© 2001 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2001, 193, 73-77

Address for reprints: Hiroshi Tanaka, M.D., Department of Pediatrics, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan.

e-mail: hirotana@cc.hirosaki-u.ac.jp