Woman had aHUS, kidney failure after COVID-19: Case study

Delayed presentation with diffuse alveolar hemorrhage unusual, per clinicians

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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A 78-year-old woman developed atypical hemolytic uremic syndrome (aHUS) and acute kidney failure after contracting an infection with SARS-CoV-2, the virus that causes COVID-19, doctors wrote in a case study.

Diffuse alveolar hemorrhage, a condition characterized by bleeding from the lung’s alveoli, or the tiny air sacs where gas exchanges take place, was among her symptoms.

“Delayed presentation of atypical HUS post-COVID-19 with diffuse alveolar haemorrhage is uncommon,” the clinicians wrote in the report, “Diffuse alveolar haemorrhage due to atypical hemolytic uremic syndrome (aHUS) associated with COVID-19,” published in the journal Respirology Case Reports.

aHUS is a type of thrombotic microangiopathy (TMA), a group of diseases in which blood clots form in small blood vessels, leading to organ damage, especially in the kidneys. The condition is caused by the abnormal activation of the complement cascade, a group of immune system proteins that normally help fight off disease-causing microbes.

It is marked by a trio of symptoms: hemolytic anemia (anemia driven by red blood cell destruction), low platelet counts (thrombocytopenia), and acute kidney failure.

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Rare lung bleeding may be sign of undiagnosed aHUS, per case report

Shortness of breath, bloody cough prompt ER visit

Clinicians at Houston Methodist Hospital described the case of a woman who was diagnosed with aHUS after contracting COVID-19.

The woman was admitted to the emergency department after developing shortness of breath and coughing up blood. She had had severe COVID-19 in the month prior to admission. Her heart rate was slightly elevated, but her blood pressure was normal. Her blood oxygen levels were low, at 70%.

Lab work revealed she was anemic and had low platelet counts. A blood smear revealed the presence of schistocytes, or red blood cell fragments. She was also found to have acute kidney failure.

A CT scan of her chest showed diffuse ground-glass opacities, a radiologic feature seen in various lung diseases.

She underwent an emergency bronchoscopy — a minimally invasive procedure to examine the inside of the lungs and air passages — that revealed diffuse alveolar hemorrhage. No infection was detected in the lung tissue sampled during the procedure.

Further tests confirmed the presence of hemolysis, or red blood cell destruction, and showed the activity of the ADAMTS-13 enzyme was low. The activity of this enzyme is commonly used to distinguish aHUS from another form of TMA in which ADAMTS-13 activity is virtually nonexistent. The woman’s complement levels were normal, and a kidney biopsy showed signs of TMA.

She received treatment with plasma exchange, or plasmapheresis, and Soliris (eculizumab). Plasmapheresis is a type of treatment used to clean the blood by removing and replacing a person’s plasma, the liquid portion of blood that contains water, salts, and proteins such as antibodies.

However, her respiratory function continued to decline, and she died.

“COVID-19 has recently been identified as a trigger for acute illness or relapse of aHUS,” the authors wrote, noting that the delayed presentation of aHUS following infection with diffuse alveolar hemorrhage was unusual.