Haemolytic uraemic syndrome with acute kidney injury following paraphenylenediamine-containing hair dye ingestion

Abstract

Abstract A 20-year-old male patient presented with an alleged history of consumption of 80 mL of paraphenylenediamine (PPD) hair dye. At initial presentation, throat pain, anasarca and reduced urine output were evident. On general physical examination, tachycardia and tachypnoea were evident; blood pressure was 130/80 mm Hg. Oxygen saturation measured with a pulse oximeter (SpO2) on ambient air was 98%. Laboratory investigations revealed haemoglobin (Hb) 14.7 g/dL, platelets 250,000/mm3, neutrophilic leucocytosis, total leucocyte count 23,600/mm3, 86% neutrophils) elevated serum creatinine (6.8 mg/dL), creatine phosphokinase levels (1466 IU/L), hyperkalaemia (6.2 mEq/L) and myoglobinuria. Abdominal ultrasonography revealed normal-sized kidneys and grade 2 renal parenchymal disease changes with maintained corticomedullary differentiation indicating acute kidney injury. Laboratory investigations done on day 7 of admission revealed anaemia Hb 9 g/dL, thrombocytopenia platelets 73,000/mm3, haemoglobinuria and elevated serum lactate dehydrogenase levels (3005 IU/L) with a negative direct and indirect Coombs test and schistocytes (5%) on peripheral smear suggesting microangiopathic haemolytic anaemia. Serum calcium, magnesium and phosphorous were within normal limits. Urinalysis showed plenty of red blood cells with dysmorphia. Haemolytic uraemic syndrome (HUS) was diagnosed and 15 sessions of haemodialysis as well as 7 sessions of plasma exchange were instituted. Clinical improvement was noted with improvement in urinary output; normalisation of laboratory parameters occurred over the next 3 weeks. He was discharged in a haemodynamically stable state. The present case highlights the unusual occurrence of HUS secondary to a hair dye (PPD) poisoning which responded to plasma exchange treatment.