Title : An atypical case of EPEC HUS in an adult
Abstract:
Introduction: Hemolytic Uremic Syndrome (HUS) is a life-threatening condition characterized by hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). It is commonly associated with Shiga toxin-producing Escherichia coli (STEC). However, Enteropathogenic Escherichia coli (EPEC), a known cause of severe pediatric diarrhea, has rarely been reported as an etiology of HUS in adults. Due to its atypical presentation, EPEC-HUS can be challenging to diagnose, delaying appropriate management. We present a rare case of EPEC-HUS in an adult, highlighting the importance of early recognition and intervention.
Case Presentation: A previously healthy 41-year-old female presented with acute gastroenteritis symptoms, including nausea, vomiting, and diarrhea. She subsequently developed severe hemolytic anemia, thrombocytopenia, and AKI, consistent with HUS. Stool testing for STEC was negative, prompting further diagnostic evaluation. Molecular testing and serotyping confirmed EPEC as the causative agent. The patient required aggressive supportive care, including intravenous fluids, blood transfusions, and renal replacement therapy. With comprehensive treatment, she showed gradual improvement, her hematological parameters normalized, renal function recovered, and she was discharged in stable condition. This case underscores the need for clinicians to consider EPEC in HUS cases, particularly when initial STEC testing is negative.
Discussion: EPEC is a recognized cause of diarrhea but is rarely linked to HUS. Unlike STEC, which produces Shiga toxin leading to endothelial injury, EPEC’s mechanism in HUS remains unclear. Limited literature exists on EPEC-associated HUS, making diagnosis challenging. This case highlights the importance of molecular testing when standard STEC diagnostics are negative. Early identification allows for timely intervention, improving patient outcomes. Raising awareness about EPEC-HUS can aid in better recognition and management of this uncommon condition.
Prevention: Preventing EPEC infections relies on proper hygiene, including handwashing with soap and water after using the bathroom, handling diapers, or preparing food.
Conclusion: This case highlights the importance of recognizing atypical pathogens like EPEC as potential causes of HUS. When STEC testing is negative, clinicians should consider alternative infectious etiologies and pursue molecular diagnostics. Early recognition and supportive management are crucial in improving outcomes. Further research is needed to better understand the pathogenesis and risk factors associated with EPEC-HUS. Increasing awareness among healthcare providers will aid in prompt diagnosis and appropriate treatment, ultimately reducing morbidity and mortality.
