Kelham Matthew D, Gleeson Liam, Alcalde Inma, Spiritoso Rosalba, Proudfoot Alastair G, Scully Marie
Perioperative Medicine Department, St Bartholomew's Hospital, London, UK.
Haematology Department, University College London Hospital, London, UK.
J Intensive Care Soc. 2020 May;21(2):191-193. doi: 10.1177/1751143719832184. Epub 2019 Mar 7.
A 19-year-old female with no medical history presented with bloody diarrhoea. Investigations revealed an acute kidney injury, thrombocytopenia and microangiopathic haemolysis. A diagnosis of haemolytic uraemic syndrome secondary to Shiga toxin-producing 055 was confirmed and supportive therapy commenced in the intensive therapy unit. On day 11 of her admission, she rapidly deteriorated with evidence of refractory cardiogenic shock and neurological involvement, both features associated with a poor prognosis. Cross-specialty collaboration prompted a trial of veno-arterial extra-corporeal membrane oxygenation and Eculizumab, a complement inhibitor normally reserved for atypical haemolytic uraemic syndrome, as a bridge to organ recovery. To our knowledge, herein we present the first adult patient with haemolytic uraemic syndrome induced cardiogenic shock successfully supported to cardiac recovery with extra-corporeal membrane oxygenation. The potential role for Eculizumab in Shiga toxin-producing /typical haemolytic uraemic syndrome is also discussed.
一名无病史的19岁女性出现血性腹泻。检查发现急性肾损伤、血小板减少和微血管病性溶血。确诊为产志贺毒素055继发的溶血尿毒综合征，并在重症监护病房开始支持治疗。入院第11天，她病情迅速恶化，出现难治性心源性休克和神经受累的迹象，这两个特征均与预后不良有关。跨专业协作促使尝试采用静脉-动脉体外膜肺氧合以及依库珠单抗（一种通常用于非典型溶血尿毒综合征的补体抑制剂）作为器官恢复的桥梁。据我们所知，本文介绍了首例成功通过体外膜肺氧合支持至心脏恢复的溶血尿毒综合征诱发心源性休克的成年患者。还讨论了依库珠单抗在产志贺毒素/典型溶血尿毒综合征中的潜在作用。
