Fatal hemolytic uremic syndrome associated with day care surgery and anaesthesia: a case report

BMC Research Notes

Markus Castegren²  Anna Myrnäs¹ 

[1] Department of Anaesthesia, Intensive Care Medicine, Sörmland County Hospital/Mälarsjukhuset, Eskilstuna, Sweden;Department of Medical Sciences, Infectious Diseases, Uppsala University, Uppsala, Sweden

关键词: General anaesthesia;    Day care surgery;    Plasmapheresis;    Thrombotic thrombocytopenic purpura;    Thrombotic microangiopathy;   

Others  :  1142380
DOI  :  10.1186/1756-0500-6-242

 received in 2013-01-14, accepted in 2013-06-24,  发布年份 2013

【 摘 要 】

Background

Thrombotic angiopathies, i.e. haemolytic uremic syndrome and thrombotic thrombocytopenic purpura, are thought to occur in patients with a combination of risk factors (e.g., an infection with shiga-toxin-producing Escherichia coli (E. coli) or low activity of the metalloproteinase Adamts-13) and a pathophysiological trigger (e.g., anti-endothelial antibodies, cytokines or activation of chemokine receptor 4). To our knowledge, this is the first report describing an association between haemolytic uremic syndrome and routine surgery and anaesthesia.

Case presentation

We present a case in which a 67-year-old Caucasian female developed fatal haemolytic uremic syndrome in the immediate postoperative period of uncomplicated day care surgery. The patient had suffered gastrointestinal symptoms followed by confusion approximately two weeks before surgery, but had been without any symptoms in the week before surgery. Haemolytic uremic syndrome with cerebral symptoms ranging from initial anxiety to subsequent seizures and coma developed within a few hours after the end of surgery. In addition, acute kidney failure and severe thrombocytopenia occurred about the same time. During intensive care, the patient was found to be positive for enterohaemorrhagic E. coli (EHEC) in faeces.

Conclusion

Anaesthesiologists should be notified that haemolytic uremic syndrome is an uncommon differential diagnosis in patients with postoperative seizures and coma. Patients with a recent enterohemmoragic E.Coli infection should be followed postoperatively for signs of haemolytic uremic syndrome.

【 授权许可】

   
2013 Myrnäs and Castegren; licensee BioMed Central Ltd.

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