Sudden Cardiac Arrest and Malignant Ventricular Tachycardia in an 8-Year-Old Pediatric Patient Who Has Hemolytic Uremic Syndrome Associated with Shiga Toxin-Producing Escherichia coli

Abstract

Gastrointestinal, neurological, pancreatic, hepatic, and cardiac dysfunction are extrarenal manifestations of hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC-HUS). The most frequent cause of death for STEC-HUS is related to the central nervous system and cardiovascular system. Cardiac-origin deaths are predominantly related to thrombotic microangiopathy-induced ischemia and the immediate development of circulatory collapse. STEC-HUS cardiac related deaths in children are rare with only sporadic cases reported. In our literature search, we did not come across any pediatric case report about STEC-HUS causing sudden cardiac arrest and malignant ventricular tachycardia (VT). Herein, we report the case of an 8-year-old female child with a typical clinical manifestation of STEC-HUS. On the seventh day of pediatric intensive care unit admission, the patient had a sudden cardiac arrest, requiring resuscitation for 10 minutes. The patient had return of spontaneous circulation with severe monomorphic pulsed malignant VT. Intravenous treatment with lidocaine, amiodarone and magnesium sulfate were promptly initiated, and we administered multiple synchronized cardioversions, but VT persisted. Furthermore, we were not able to ameliorate her refractory circulation insufficiency by advanced cardiopulmonary resuscitation. Thus, inevitably, the patient lost her life. This case illustrates the need for aggressive management and the dilemma that pediatric critical care specialists, cardiologists, and nephrologists have to face when dealing with STEC-HUS that is worsened by a sudden cardiac arrest accompanied with VT.

Keywords

intracranial hemorrhage - ventricular tachycardia - hemolytic uremic syndrome - cardiopulmonary resuscitation - pediatric intensive care unit

Publikationsverlauf

Eingereicht: 15. Dezember 2019

Angenommen: 16. Februar 2020

Artikel online veröffentlicht:
07. April 2020

• References

• 1 Canpolat N. Hemolytic uremic syndrome. Turk Pediatri Ars 2015; 50 (02) 73-82
• 2 F Andersen R, V Bjerre J, V Povlsen J, Veien M, Kamperis K, Rittig S. HUS-induced cardiac and circulatory failure is reversible using cardiopulmonary bypass as rescue. Pediatr Nephrol 2017; 32 (11) 2155-2158
• 3 Karpman D, Loos S, Tati R, Arvidsson I. Haemolytic uraemic syndrome. J Intern Med 2017; 281 (02) 123-148
• 4 Oakes RS, Siegler RL, McReynolds MA, Pysher T, Pavia AT. Predictors of fatality in postdiarrheal hemolytic uremic syndrome. Pediatrics 2006; 117 (05) 1656-1662
• 5 Khalid M, Andreoli S. Extrarenal manifestations of the hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli (STEC HUS). Pediatr Nephrol 2019; 34 (12) 2495-2507
• 6 Nathanson S, Kwon T, Elmaleh M. et al. Acute neurological involvement in diarrhea-associated hemolytic uremic syndrome. Clin J Am Soc Nephrol 2010; 5 (07) 1218-1228
• 7 Mohammed J, Filler G, Price A, Sharma AP. Cardiac tamponade in diarrhoea-positive haemolytic uraemic syndrome. Nephrol Dial Transplant 2009; 24 (02) 679-681
• 8 Abu-Arafeh I, Gray E, Youngson G, Auchterlonie I, Russell G. Myocarditis and haemolytic uraemic syndrome. Arch Dis Child 1995; 72 (01) 46-47
• 9 Ridolfi RL, Hutchins GM, Bell WR. The heart and cardiac conduction system in thrombotic thrombocytopenic purpura. A clinicopathologic study of 17 autopsied patients. Ann Intern Med 1979; 91 (03) 357-363
• 10 Prakash J, Gupta S, Kumar H, Rawat UB. Recurrent ventricular tachycardia complicating atypical haemolytic-uraemic syndrome. Nephrol Dial Transplant 1998; 13 (09) 2419-2420
• 11 Gallo EG, Gianantonio CA. Extrarenal involvement in diarrhoea-associated haemolytic-uraemic syndrome. Pediatr Nephrol 1995; 9 (01) 117-119
• 12 Buelli S, Zoja C, Remuzzi G, Morigi M. Complement activation contributes to the pathophysiology of Shiga toxin-associated hemolytic uremic syndrome. Microorganisms 2019; 7 (01) 15
• 13 Ağbaş A, Göknar N, Akıncı N. et al. Outbreak of Shiga toxin-producing Escherichia-coli-associated hemolytic uremic syndrome in Istanbul in 2015: outcome and experience with eculizumab. Pediatr Nephrol 2018; 33 (12) 2371-2381
• 14 Loos S, Oh J, Kemper MJ. Eculizumab in STEC-HUS: need for a proper randomized controlled trial. Pediatr Nephrol 2018; 33 (08) 1277-1281
• 15 Mahat U, Matar RB, Rotz SJ. Use of complement monoclonal antibody eculizumab in Shiga toxin producing Escherichia coli associated hemolytic uremic syndrome: A review of current evidence. Pediatr Blood Cancer 2019; 66 (11) e27913
• 16 Percheron L, Gramada R, Tellier S. et al. Eculizumab treatment in severe pediatric STEC-HUS: a multicenter retrospective study. Pediatr Nephrol 2018; 33 (08) 1385-1394