Rare Case of Enteropathogenic Escherichia coli Causing Hemolytic Uremic Syndrome

Introduction: Association of Shigella and EnteroHemorrhagic E.Coli strain O157:H71 causing HUS has long been established and is known as typical HUS. Atypical HUS is caused by mutation causing abnormal complement activation. EPEC is a rare cause of diarrhea in adults and people who live in developed countries. Case Description: A 40-year-old female with no significant medical history presented with complaints of nausea, vomiting, and diarrhea for 3 days. She also had blood in her urine and decreased urine output. Her diarrhea was watery in nature with few streaks of blood. She also reported a fever spike of 100.5 F. She had associated decreased appetite and abdominal pain. She denied any blood in vomitus, recent travel, or eating outside food. Her vital signs were revealing of tachycardia and fever. Her abdomen was diffusely tender to palpation. Her labs showed decreased hemoglobin, elevated creatinine 6.27, platelets 14000, troponin 9888, bilirubin 3.29, and CK 1122. Her ADAMTS-13 levels were low. Peripheral smear showed schistocytes. She also had elevated LDH, ferritin, and low haptoglobin. She was transfused with 8 units of PRBCs. She underwent plasma exchange due to concerns of TTP-HUS from STEC, but the stool studies were positive for EPEC. Therefore, she was started on steroids and later transitioned to supportive treatment. She also required dialysis and aggressive management of her hypertension. Discussion: Though most cases of HUS are associated with Shigella and EHEC O157:H71, thorough work up is required to rule out causes including genetic causes, atypical HUS to provide appropraite treatment to the patient. EPEC causes watery diarrhea and EHEC causes bloody diarrhea. Appropriate management depends on the underlying cause of the microangiopathy whcich is not always established and includes a wide range of treatment options from supportive care to RBC transfusion, plasma exchange, dialysis and anti-complement therapy.