OBJECTIVE: Pneumococcal diseases are a major public health problem. Severe hemolytic-uremic syndrome is an uncommon complication. The aim of this study is to report a child with this complication. CASE DESCRIPTION: A male child with 17 months old was admitted to the hospital, due to acute respiratory failure, needing ventilatory support. Roentgenogram demonstrated massive condensation of right lung and Streptococcus pneumonia was isolated from blood cultures. Laboratory tests showed hemoglobin level of 6.5g/dL, 38,000 platelets/mm³, blood urea nitrogen of 79mg/dL and creatinine of 1.64mg/dL. On the first day, patient developed oliguria and hypervolemia and needed hemodiafiltration. Multiple organs dysfunction syndrome was followed by death on the seventh day. Necropsy showed extensive renal cortical and tubular necrosis with fibrin deposits on arterioles. COMMENTS: Hemolytic-uremic syndrome complicating invasive pneumococcal disease has high morbidity and mortality rates. Children with pneumococcal infection and severe hematologic or renal abnormalities should be investigated. The usefulness of early recognition of T-antigen activation on diagnosis and therapeutics, the role of complement factor H in the pathology, the ideal renal replacement method and the definition of long term outcome are issues to be investigated.
hemolytic-uremic syndrome; Streptococcus pneumoniae; neuraminidase
