Peripheral nervous system manifestations of Shiga toxin-producing E. coli-induced haemolytic uremic syndrome in children

• Published in: Italian journal of pediatrics 2021-09, Vol.47 (1), p.181-181, Article 181
• Main Authors: Santangelo, Luisa, Netti, Giuseppe Stefano, Torres, Diletta Domenica, Piscopo, Giovanni, Carbone, Vincenza, Losito, Luciana, Milella, Leonardo, Lasorella, Maria Luigia, Conti, Pasquale, Gagliardi, Delio, Chironna, Maria, Spadaccino, Federica, Bresin, Elena, Trabacca, Antonio, Ranieri, Elena, Giordano, Mario
• Format: Article
• Language: English
• Subjects: Anemia; Anti-Inflammatory Agents - therapeutic use; Basal ganglia; Blood pressure; Case Report; Child; Child, Preschool; Coma; Creatinine; Diarrhea; E coli; Eculizumab; Electroencephalography; Enterohemorrhagic Escherichia Coli; Escherichia coli Infections; Female; Hemolytic uremic syndrome; Hemolytic-Uremic Syndrome - complications; Hemolytic-Uremic Syndrome - therapy; Humans; Hypokalemia; Hypoxia; Immunoglobulins; Immunoglobulins, Intravenous - therapeutic use; Immunosuppressive agents; Infectious diseases; Laboratories; Methylprednisolone; Methylprednisolone - therapeutic use; Nephrology; Nervous system; Neurological complications; Neurological Rehabilitation; Neurorehabilitation; Neutrophils; Patients; Pediatrics; Peripheral nervous system; Plasma Exchange; Polyneuropathies - etiology; Polyneuropathies - therapy; Polyneuropathy; Potassium; Recovery of function; Rehabilitation; Renal replacement therapy; Shiga toxin; Shiga-Toxigenic Escherichia coli; Streptococcus infections; Substantia alba; Thrombocytopenia; Ventilators; Visual impairment
• ISSN: 1824-7288; 1720-8424; 1824-7288
• DOI: 10.1186/s13052-021-01133-1

The Neurological involvement is the most common extra-renal complication of Shiga toxin-producing E. coli-hemolytic uremic syndrome (HUS) or typical HUS. On brain magnetic resonance examination, main neurological signs encompass acute lesions of the basal ganglia and the white matter, which could usually regress after Eculizumab infusion. In contrast, peripheral nervous system (PNS) manifestations in typical HUS are very rare and, when occurring, they require a careful management of neurological sequelae and an intensive multidisciplinary neuro-rehabilitation program. Here, we present two pediatric cases of severe and complicated typical HUS with PNS manifestations who required therapeutic treatment and an intensive multidisciplinary neuro-rehabilitation program. In both cases, PNS manifestations were followed by the recovery from typical HUS-related severe central neurological damage and manifested mainly with marked bilateral motor deficit and hyporeflexia/areflexia in the lower limbs. The peripheral polyneuropathy was treated with immunosuppressive therapy (methylprednisolone boluses, i.v. immunoglobulins, plasma exchange), followed by a prolonged intensive neuro-rehabilitation program. After 8 months of rehabilitation, both patients gained complete functional recovery. PNS manifestations during typical HUS are a rare event and potentially leading to severe disability. A timely clinical assessment is mandatory to set up a prompt therapeutic and rehabilitation program and to obtain a complete clinical and functional recovery.