未经评估:随着全球大流行的持续,COVID-19在儿科人群中出现了新的并发症,其中之一是溶血性尿毒综合征(HUS),补体介导的血栓性微血管病(CM-TMA),以血小板减少症三联征为特征,微血管病性溶血性贫血和急性肾损伤(AKI)。由于儿童多系统炎症综合征(MIS-C)和HUS共享补体失调是关键因素之一,本病例报告的目的是强调这两种情况之间的差异,并强调补体阻断作为一种治疗方式的重要性.
未经证实:我们描述了一名21个月大的幼儿,他最初表现为发烧,并确诊为COVID-19。他的病情迅速恶化,出现少尿,伴有腹泻,呕吐和口服摄入不耐受。HUS被怀疑,有令人信服的实验室发现支持,包括血小板计数和C3水平下降,LDH升高,尿素,血清肌酐和sC5b-9以及外周血中分裂细胞的存在,粪便志贺毒素阴性和ADAMTS13金属蛋白酶活性正常。患者给予C5补体阻断剂Ravulizumab并开始显示快速改善。
未经评估:尽管在COVID-19的背景下,HUS的报告继续涌入,与MIS-C的确切机制和相似性的问题仍然存在。我们的案例首次强调了在这种情况下使用补体阻断作为一种有价值的治疗选择。我们真诚地相信,将HUS报告为儿童COVID-19的并发症,将改善诊断和治疗,以及更好地理解这两种错综复杂的疾病。
UNASSIGNED: As the global pandemic continues, new complications of COVID-19 in pediatric population have turned up, one of them being hemolytic uremic syndrome (HUS), a complement-mediated thrombotic microangiopathy (CM-TMA) characterized by triad of thrombocytopenia, microangiopathic hemolytic anemia and acute kidney injury (AKI). With both multisystem inflammatory syndrome in children (MIS-C) and HUS sharing complement dysregulation as one of the key factors, the aim of this case report is to highlight differences between these two conditions and also emphasize the importance of complement blockade as a treatment modality.
UNASSIGNED: We describe a 21-month-old toddler who initially presented with fever and confirmed COVID-19. His condition quickly deteriorated and he developed oliguria, accompanied with diarrhea, vomiting and oral intake intolerance. HUS was suspected, supported with compelling laboratory findings, including decreased platelets count and C3 levels, elevated LDH, urea, serum creatinine and sC5b-9 and presence of schistocytes in peripheral blood, negative fecal Shiga toxin and normal ADAMTS13 metalloprotease activity. The patient was given C5 complement blocker Ravulizumab and started to display rapid improvement.
UNASSIGNED: Although reports of HUS in the setting of COVID-19 continue to pour in, the questions of exact mechanism and similarities to MIS-C remain. Our case for the first time accentuates the use of complement blockade as a valuable treatment option in this scenario. We sincerely believe that reporting on HUS as a complication of COVID-19 in children will give rise to improved diagnosis and treatment, as well as better understanding of both of these intricating diseases.