Hemolytic uremic syndrome complicating whooping cough

Abstract

Introduction. We shall present a case of a two-month old infant who has developed a haemolytic uremic syndrome as an atypical complication of Bordetella pertussis infection. The observation that the development of haemolytic uremic syndrome is a late complication of Bordetella pertussis infection may be a clue for further studies. Case outline. A two-month-old female infant was admitted to the hospital because of fever, intensive cough, shortness of breath and poor feeding. Real-time polymerase chain reaction (PCR) for Bordetella pertussis was positive. A macrolide was introduced in therapy. On the eighth hospital day, the infant?s condition improved, she became afebrile and eupneic. On the 16th hospital day, she developed signs of progressive respiratory distress and oliguric acute kidney injury. Hemolytic uremic syndrome (HUS) was diagnosed, so the therapy with the fresh frozen plasma (FFP) transfusion, therapeutic plasma exchange and peritoneal dialysis was initiated. Levels of ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) were decreased, while the levels of factor H, factor B, and factor I were normal. Despite the full supportive and targeted care, severe multiple organ failure had developed and on the 24th hospital day the infant died. Conclusion. Further studies are necessary to identify the mechanism of potential interaction between pertussis toxins, pathophysiology of the infection and the interaction of complement activation, coagulation and the regulation of these cascades.