Boy With aHUS Develops Severe COVID-19 Infection, Case Study Reports

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by Vanda Pinto PhD |

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An 11-year-old boy with atypical hemolytic uremic syndrome (aHUS) became severely ill following infection with SARS-CoV-2, the virus that causes COVID-19, according to a recent case report.

“Our study [shows] that severe SARS-COV-2 infection can be developed in pediatric patients with co-existing [aHUS],” the author wrote.

The report, “Severe SARS-COV-2 infection in pediatric patient with atypical Hemolytic Uremic Syndrome: A case report,” was published in Annals of Medicine and Surgery.

aHUS refers to a group of diseases wherein blood clots form in small blood vessels and damage several organs, particularly the kidneys. The three main features of aHUS are hemolytic anemia, caused by the destruction of red blood cells, low platelet counts, and acute kidney failure.

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The disorder is caused by a dysfunction of the complement cascade, a part of the immune system that defends the body against bacteria and viruses. When the complement system becomes overactive it can lead to severe inflammation and blood clotting.

In children, HUS is classified as typical, or diarrhea-associated, when its development is triggered by a gastrointestinal infection caused by certain bacteria, such as Escherichia coli, and as atypical when it’s not. Among children with HUS, 90% have the typical form of the disease.

A researcher from Omdurman Islamic University in Sudan described the case of a boy with aHUS who developed severe COVID-19.

Although children appear to be at less risk of developing severe COVID-19 compared with adults, the researcher said the impact of aHUS is “yet to be determined.”

The boy’s symptoms started with a sore throat, which doctors initially diagnosed as tonsillitis and treated with amoxicillin-clavulanic acid, an antibiotic combination. He then developed a skin rash believed to be caused by an allergic reaction to an antihistamine.

His symptoms worsened a week later. He had generalized body swelling, a skin rash and red-colored urine, indicating the presence of blood in the urine. He had no fever and his blood oxygen levels were normal, however.

The boy had symptoms usually found in people with hemolytic anemia, such as an enlarged liver and a heart murmur.

Lab tests showed the presence of anemia, schistocytes (red blood cell fragments), abnormally shaped red blood cells, and decreased kidney function. His platelet levels were normal, however, and he only had mildly high levels of neutrophils — white blood cells that defend the body against infections.

Despite treatment with antibiotics, anti-inflammatory methylprednisolone, and medications to help reduce swelling, the boy did not improve. He was put on plasma transfusions and regular hemodialysis.

While admitted, he was diagnosed with COVID-19 after he developed a fever and began having severe shortness of breath. He was admitted to the intensive care unit for breathing support two days later.

“This study highlights a rare case of [aHUS] that is commonly missed in real practice,” the researcher wrote. “To our knowledge no study highlighted the severity of SARS-COV-2 infection in pediatric patients with [aHUS].”

The researcher noted aHUS has been reported to relapse in the setting of viral illnesses like the flu, and that some researchers have suggested including COVID-19 as a triggering factor for aHUS relapse.