Journal of the Formosan Medical Association
Volume 106, Issue 2, Supplement , Pages S17-S22, 2007

Unusual Manifestation of Severe Conjugated Hyperbilirubinemia in an Infant with Streptococcus pneumoniae-associated Hemolytic Uremic Syndrome

  • Jung-Pin Chen

      Affiliations

    • Division of Pediatric Nephrology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
    • ,
  • Shan-Ming Chen

      Affiliations

    • Division of Pediatric Gastroenterology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
    • ,
  • Ji-Nan Sheu

      Affiliations

    • Division of Pediatric Nephrology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
    • Division of Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Ji-Nan Sheu Division of Pediatric Nephrology, Department of Pediatrics, Chung Shan Medical University Hospital, 110, Section 1, Chien-Kuo North Road, Taichung 402, Taiwan

Received 7 December 2005; received in revised form 12 January 2006; accepted 4 April 2006.

Article Outline

Streptococcus pneumoniae is an uncommon etiologic organism in children with hemolytic uremic syndrome (HUS). Historically, severe S. pneumoniae-associated HUS usually has a poor clinical outcome. The clinical manifestations of marked jaundice and hepatic dysfunction in this form of HUS are extremely rare. We report a 10-month-old female infant with S. pneumoniae-associated HUS who had the unusual manifestation of severely elevated conjugated bilirubin and hepatic transaminases. Screening for viral hepatitis was negative, and evidence of biliary obstruction and hepatotoxic drug exposure was also absent. The patient was treated with antihypertensive agents for 2.5 months and required peritoneal dialysis for a period of 26 days. Hepatic function returned to normal on the 8th day of hospitalization. Renal function was mildly impaired at 1-year follow-up. Our report suggests that severe conjugated hyperbilirubinemia is a rare manifestation of S. pneumoniae-associated HUS in children. It is important for pediatricians that pneumococcal infection with severe hematologic and renal disorders should be investigated for evidence of S. pneumoniae-associated HUS. [J Formos Med Assoc 2007;106(2 Suppl):S17-S22]

Key Words:  conjugated hyperbilirubinemia , hemolytic uremic syndrome , hepatic function , renal function , Streptococcus pneumoniae

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PII: S0929-6646(09)60347-8

doi:10.1016/S0929-6646(09)60347-8

Journal of the Formosan Medical Association
Volume 106, Issue 2, Supplement , Pages S17-S22, 2007

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