Case Report
A Case of Hemolytic Uremic Syndrome Associated with Emphysematous Cholecystitis and a Liver Abscess
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KAZUNORI YOSHIDA, MASAHIRO ARAKAWA,1 SHYUICHI ISHIDA1 and YASUHIKO SASAKI1
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Section of Internal Medicine and Disability Prevention, Disability Science, Tohoku University Graduate School of Medicine, Sendai 980-8574, and 1Department of Internal Medicine, Ishinomaki Red Cross Hospital, Ishinomaki 986-0015
Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Most cases of HUS are characterized by a prodromal phase of diarrhea and melena, and affect mainly children. Here we report a unique case of adult-onset HUS that was associated with emphysematous cholecystitis and a liver abscess. The patient did not suffer from diarrhea or melena on admission, but abdominal CT scans revealed emphysematous cholecystitis and a liver abscess. Cholecystectomy was performed and the liver abscess was drained. Cultures of the bile and liver abscess contents were negative, but the serum samples had antibodies against Escherichia coli (E. coli) O157. The patient was anuric for 14 days, and underwent hemodialysis that was repeated 15 times and plasma exchanges 6 times. She recovered from acute renal failure but with inadequate urinary concentrating ability as a sequela. Histopathological examination of renal biopsy specimens on the 83rd hospital day revealed almost normal glomeruli and patchy atrophy of tubules with an increase of interstitium. This is a very rare case of HUS associated with emphysematous cholecystitis and a liver abscess successfully treated with aggressive supportive care. It is possible that an infection with verotoxin-producing E. coli O157 caused the disease.
Key words---
hemolytic uremic syndrome; cholecystitis; liver abscess; Escherichia coli O157; verotoxin
© 1998 Tohoku University Medical Press
Tohoku J. Exp. Med., 1998, 185, 147-155
Address for reprints:
Kazunori Yoshida M.D., Section of Internal Medicine and Disability Prevention, Disability Science, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
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