TYPICAL HEMOLYTIC UREMIC SYNDROME WITH AN ATYPICAL CLINICAL COURSE, ROTAVIRUS COINFECTION, AND MAJOR GASTROINTESTINAL COMPLICATION: CASE REPORT AT NIÑOS DE ACOSTA ÑU GENERAL PEDIATRIC HOSPITAL, 2025

Abstract

This study aims to report the case of a 9-year-old female patient with no previously known comorbidities who presented with a clinical condition compatible with hemolytic uremic syndrome (HUS), associated with rotavirus detection and severe clinical progression. Her relevant medical history included hospitalization in 2022 due to multisystem inflammatory syndrome in children (MIS-C) following COVID-19. The patient, a resident of Germany, developed symptoms two days after arriving in Paraguay on June 30, 2025, including diarrhea with bloody streaks, vomiting, and fever. Stool examination revealed occult blood and a positive rotavirus test, as well as a high number of leukocytes and erythrocytes in fecal mucus. Initially treated as an outpatient with cefixime, she subsequently developed hypotensive shock, altered mental status, thrombocytopenia, and acute kidney dysfunction, with significantly elevated urea and creatinine levels. She was referred to the Pediatric Intensive Care Unit with septic shock of probable enteric origin and suspected HUS, requiring mechanical ventilation and intensive supportive care. During hospitalization, she developed anuric renal failure requiring renal replacement therapy, significant pericardial effusion requiring urgent drainage, cardiac arrest successfully reversed through resuscitation, and gastrointestinal bleeding complications, including rectal bleeding. In the context of multiple organ failure and a hyperinflammatory response, immunomodulatory treatment with human immunoglobulin and methylprednisolone pulse therapy was initiated. This case highlights the atypical and potentially severe clinical course of HUS associated with rotavirus detection, emphasizing the diagnostic and therapeutic challenges posed by multisystem involvement and major gastrointestinal complications.