A case report of a child with sepsis induced multiorgan failure and massive complement consumption treated with a short course of Eculizumab: A case of crosstalk between coagulation and complement?

• Published in: Medicine (Baltimore) 2019-01, Vol.98 (4), p.e14105-e14105
• Main Authors: Galic, Slobodan, Csuka, Dorottya, Prohászka, Zoltán, Turudic, Daniel, Dzepina, Petra, Milosevic, Danko
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Clinical Case Report; Clostridium Infections - complications; Clostridium Infections - therapy; Complement System Proteins - metabolism; Dialysis; Disseminated Intravascular Coagulation - complications; Disseminated Intravascular Coagulation - therapy; Humans; Immunosuppressive Agents - therapeutic use; Infant; Male; Multiple Organ Failure - complications; Multiple Organ Failure - therapy; Plasmapheresis; Sepsis - complications; Sepsis - therapy
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000014105

This article describes a child with a life-threatening multiorgan failure with disseminated intravascular coagulation (DIC) and massive complement consumption. To our knowledge this therapeutic approach was for the first time effectively applied in a pediatric patient. A 14-month-old boy was presented with a severe, rapidly progressing, life-threatening disease because of sudden onset of fever, hemathemesis, hematuria, and bloody diarrhoea alongside fast spreading hematomas and general corporeal edema. The most plausible diagnosis in our patient is Clostridium difficile sepsis-induced thrombotic microangiopathy alongside with DIC and consumption coagulopathy. The diagnosis was confirmed by positive C difficile bacteria strain in coproculture, clinical, and laboratory tests affirming DIC and global complement activation and consumption. The patient was treated with antibiotics (Metronidazole, Vancomycin), plasmapheresis, dialysis, methylprednisolone, mycophenolate mofetil, and Eculizumab. The child is in fair overall condition in a 2 year follow-up with no complications save chronic renal failure. In rare cases of sepsis with massive complement consumption, a case-sensitive Eculizumab therapy may be at least considered after the resolution of life-threatening multiorgan failure. The application of this drug can be performed only after sepsis induced disease is put under control. A fast withdrawal of Eculizumab after control of massive complement consumption is recommended to prevent triggering of second sepsis reactivation.