Nurses lead care team to heal aHUS baby’s severe skin wounds
Multidisciplinary team combined disease management, wound care
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A nurse-led care team in China successfully treated an 8-month-old boy with atypical hemolytic uremic syndrome (aHUS) who developed blistering skin wounds that hardened with calcium deposits.
In addition to normalizing his kidney function, the team used a staged, moisture-based wound-care approach that healed his wound in about seven weeks without surgery.
“This case highlights the importance of integrating systemic disease management with local wound care in pediatric aHUS complicated by rare wound complications and may provide practical guidance for the nursing care of similar complex pediatric cases,” the researchers wrote.
The study, “Nursing care of an infant with atypical hemolytic uremic syndrome complicated by spontaneous bullous rupture and dystrophic wound calcification: A case report,” was published in the Journal of Pediatric Nursing.
Case report describes complication, recovery
aHUS is a rare disorder in which blood clots form in small blood vessels, leading to the destruction of red blood cells, low platelet counts, and kidney injury. aHUS is caused in most cases by uncontrolled activation of the complement cascade, a part of the immune system.
The boy described in the case report was admitted to the hospital after a week of coughing and three days of body-wide swelling. Blood tests revealed anemia (low levels of hemoglobin, the protein that carries oxygen in red blood cells) and impaired kidney function.
Consistent with his mother’s history of aHUS, he carried a mutation in the CFH gene, which encodes a protein that regulates the complement cascade. He was diagnosed with aHUS, severe pneumonia, and nephrotic syndrome (elevated protein in the urine due to kidney dysfunction).
Treatment included breathing support, continuous blood purification, the complement-blocking drug Soliris (eculizumab), and plasma exchange, a treatment in which plasma, the liquid part of blood, is removed and replaced to eliminate disease-driving components.
However, the infant developed scattered blisters on his left upper limb by the third day of hospitalization. The blisters ruptured spontaneously, and by day 10, firm nodules could be felt within the wound. Ultrasound confirmed these were calcified deposits, an accumulation of calcium in damaged tissue.
The hospital organized a nurse-led multidisciplinary team that held daily bedside updates and reviewed the case every two days. The infant underwent seven sessions of hemodialysis and five sessions of plasma exchange, using a low-calcium solution. He also received Soliris and a course of antibiotics to prevent infection.
Wound care followed moist wound-healing principles and progressed through three stages. In the first two weeks, the team gently removed dead tissue and softened calcifications using layered dressings, which were changed every two to three days.
From weeks three through six, silver-containing foam dressings were used to prevent bacterial biofilms (clusters of bacteria), with less frequent removal of dead tissue to protect healing tissue. From week seven onward, soft silicone dressings were used to protect the newly formed skin and allow painless dressing changes.
The team also tailored the baby’s nutrition to balance his kidney condition with wound healing. He received a kidney-specific formula with high protein and limited phosphorus. Supplements of calcium carbonate with vitamin D3 were also administered with meals to reduce phosphorus absorption.
His pain was managed with a combination of continuous pain-killer infusions during mechanical ventilation, increased dosing before dressing changes, and, once he was conscious, non-drug distraction techniques such as videos and play therapy. The team removed all dressings using a silicone-based adhesive remover.
The baby’s caregivers, who had “exhibited severe anxiety and depressive symptoms,” were supported through daily communication, access to a 24-hour psychological support hotline, and a dedicated resting area in the ward.
By the time the child was discharged, the wound had fully closed into a flat, pink scar. Follow-up assessments showed marked improvement. Caregiver anxiety and depression scores also declined. The researchers found no recurrence of aHUS and no return of calcification or blistering over three months of follow-up.
“The experience gained from this case may provide evidence-informed practical guidance for the nursing management of similar complex wounds associated with systemic diseases,” the researchers wrote.
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