Dr Zena Barakat1, Lucinda Salmon2, Megan Cotter2, Holly Hutton1,2
1Department of Renal Medicine, Alfred Health, Melbourne, Australia, 2Department of Genetics, Alfred Health, Melbourne, Australia
Biography:
Zena Barakat is a final year advanced trainee at Monash Health.
Background:
Shiga toxin-producing Escherichia coli (STEC) is the leading cause of haemolytic uremic syndrome (HUS), a condition characterised by microangiopathic haemolytic anaemia, thrombocytopenia, and acute kidney injury. While supportive care remains the cornerstone of treatment, plasma exchange has been explored primarily in the paediatric population particularly in severe cases.
Case Report:
In this case report, we describe the clinical course and treatment of a 27-year-old female with severe STEC-associated HUS (STEC-HUS) with multi-organ involvement.
Despite receiving initial intensive supportive care and treatment with eculizumab, the patient's condition deteriorated significantly. After three sessions of plasma exchange, there was rapid and sustained clinical improvement, including resolution of renal failure and neurological symptoms. She was successfully weaned off dialysis, with subsequent recovery of kidney function.
Conclusion:
This case highlights the potential role of plasma exchange as a valuable treatment option in severe, rapidly progressing cases of STEC-HUS, especially when standard treatments are ineffective. Although current evidence regarding the use of plasma exchange for STEC-HUS in adults is limited, our findings support the consideration of plasma exchange in refractory cases. Given the limitations of existing treatments and the promising response to plasma exchange in this patient, further research, including randomised controlled trials, is essential to establish more definitive treatment guidelines and improve patient outcomes.