Kumar Sanjay, Bhagia Geeta, Kaae Jessica
Hospitalist, Benefis Health System, Great Falls, USA.
Internal Medicine, Benefis Health System, Great Falls, USA.
Cureus. 2022 Mar 28;14(3):e23577. doi: 10.7759/cureus.23577. eCollection 2022 Mar.
Atypical hemolytic uremic syndrome (aHUS) occurs in patients with defective alternative complement pathways, making them susceptible to thrombotic microangiopathy (thrombocytopenia, intravascular hemolysis, and renal failure), and is usually triggered by infectious agents. Influenza and Streptococcus pneumonia are known triggers for aHUS. However, influenza vaccination triggering aHUS is rarely reported. We present a 30-year-old male who presented with chills, abdominal discomfort, and night sweats after receiving the influenza vaccine. The patient had thrombocytopenia, elevated creatinine, blood urea nitrogen, liver enzymes, and bilirubin with schistocytes with peripheral smear. ADAMTS13 activity was normal so the patient was diagnosed with aHUS. The patient improved with eculizumab and was ultimately found to have a mutation in CD46, which made him susceptible to aHUS. This case shows patients with dysregulated alternative complement pathways may be predisposed to develop aHUS after receiving influenza vaccination.
非典型溶血性尿毒症综合征（aHUS）发生于替代补体途径存在缺陷的患者，使他们易患血栓性微血管病（血小板减少、血管内溶血和肾衰竭），且通常由感染因子触发。流感和肺炎链球菌是已知的aHUS触发因素。然而，流感疫苗接种引发aHUS的情况鲜有报道。我们报告一例30岁男性，在接种流感疫苗后出现寒战、腹部不适和盗汗。该患者存在血小板减少、肌酐、血尿素氮、肝酶和胆红素升高，外周血涂片可见裂体细胞。ADAMTS13活性正常，因此该患者被诊断为aHUS。患者使用依库珠单抗后病情改善，最终发现其CD46存在突变，这使其易患aHUS。该病例表明，替代补体途径失调的患者在接种流感疫苗后可能易发生aHUS。
