Kajiyama Tsubasa, Fukuda Masahumi, Rikitake Yuuichirou, Takasu Osamu
Emergency Medicine, Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume, JPN.
Gastroenterology, Advanced Emergency and Critical Care Center, Kurume University School of Medicine, Kurume, JPN.
Cureus. 2023 Feb 24;15(2):e35434. doi: 10.7759/cureus.35434. eCollection 2023 Feb.
This is a report of an extremely rare case of an atypical hemolytic uremic syndrome (aHUS) that appears to have been triggered by acute pancreatitis. A 68-year-old man was examined at a medical institution because of sudden lower abdominal pain. The patient was diagnosed with acute pancreatitis on computed tomography. Hemoglobinuria and laboratory findings indicative of intravascular hemolysis were noted. Biochemical analysis revealed normal results for von Willebrand factor activity, antiplatelet antibodies, and ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13), and stool culture was negative for Shiga-toxin-producing , leading to the diagnosis of aHUS. Treatment for acute pancreatitis resulted in improvement in the laboratory findings, and the patient's progress was monitored without treatment intervention for aHUS. On day 2 of hospitalization, the abdominal symptoms and hemoglobinuria resolved without any subsequent recurrence. In the absence of any complications, the patient was transferred back to the initial hospital on day 26 of hospitalization. When hemolytic anemia or thrombocytopenia of unknown etiology is observed, aHUS should be suspected, and clinicians should be aware that acute pancreatitis may be a potential cause of aHUS.
本文报告了一例极为罕见的非典型溶血性尿毒症综合征（aHUS），该病例似乎由急性胰腺炎引发。一名68岁男性因突发下腹部疼痛在一家医疗机构接受检查。经计算机断层扫描，该患者被诊断为急性胰腺炎。同时发现血红蛋白尿及提示血管内溶血的实验室检查结果。生化分析显示血管性血友病因子活性、抗血小板抗体及ADAMTS13（含血小板反应蛋白基序的解整合素和金属蛋白酶13）结果正常，粪便培养未检出产志贺毒素菌，从而诊断为aHUS。急性胰腺炎的治疗使实验室检查结果有所改善，且在未对aHUS进行治疗干预的情况下对患者病情进行监测。住院第2天，腹部症状和血红蛋白尿消失，且未再复发。在无任何并发症的情况下，患者于住院第26天转回最初的医院。当观察到病因不明的溶血性贫血或血小板减少症时，应怀疑aHUS，临床医生应意识到急性胰腺炎可能是aHUS的一个潜在病因。
