{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:39:57Z","timestamp":1790397597093,"version":"4.1.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2019,4,1]],"date-time":"2019-04-01T00:00:00Z","timestamp":1554076800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>To describe a case of atypical hemolytic uremic syndrome induced by influenza A infection with the p.Ile1157Thr C3 mutation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Data Sources:<\/jats:title>\n            <jats:p>Clinical observations of a patient.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Study Selection:<\/jats:title>\n            <jats:p>Case reports.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Data Extraction:<\/jats:title>\n            <jats:p>Data extracted from medical records, after patient\u2019s consent.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Data Synthesis:<\/jats:title>\n            <jats:p>Four days prior to presentation to our hospital, a 16-year-old adolescent had a fever and arthralgia with hematuria. He was found to be positive for type A influenza and prescribed oseltamivir and acetaminophen by a primary-care physician. A bleeding tendency and purpura in the extremities and on the trunk developed; therefore, he was transferred to Chiba University Hospital. Hematology revealed severe thrombocytopenia, hyperbilirubinemia, and acute kidney injury. Aspartate aminotransferase, lactate dehydrogenase, and potassium could not be determined because of severe hemolysis. Highly elevated blood urea nitrogen and creatinine levels indicated acute kidney injury. A platelet count of 24,000\/\u03bcL indicated thrombocytopenia, with low hemoglobin level. Peripheral blood profiling identified schistocytes. Continuous hemodiafiltration and plasma infusion were initiated immediately; however, he became oliguric. Plasma exchange was initiated on ICU day 3, but decreased urine output, hemolysis, and thrombocytopenia persisted. IV eculizumab therapy was initiated on day 7 and resulted in recovery of these symptoms and also successful discontinuation of renal support. The patient showed a stable condition without recurrence of hemolytic findings and acute kidney injury and is currently on maintenance therapy of eculizumab (1,200\u2009mg, every other week) without any relapse of atypical hemolytic uremic syndrome symptoms. A plasma sample collected prior to initiation of plasma exchange showed an disintegrin-like and metalloprotease with thrombospondin type 1 motifs 13 activity level of 104.9%. The absence of both Shiga toxin-producing <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic> in feces led to suspicion of atypical hemolytic uremic syndrome. Subsequent genetic analysis identified a mutation in <jats:italic toggle=\"yes\">C3<\/jats:italic> (p.Ile1157Thr), confirming the diagnosis of atypical hemolytic uremic syndrome.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Although managing thrombocytopenia secondary to infection, inclusion of atypical hemolytic uremic syndrome in the differential diagnosis at an early stage is important in clinical practice.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/cce.0000000000000008","type":"journal-article","created":{"date-parts":[[2019,4,18]],"date-time":"2019-04-18T11:32:40Z","timestamp":1555587160000},"page":"e0008","source":"Crossref","is-referenced-by-count":4,"title":["Atypical Hemolytic Uremic Syndrome With the p.Ile1157Thr C3 Mutation Successfully Treated With Plasma Exchange and Eculizumab: A Case Report"],"prefix":"10.1097","volume":"1","author":[{"given":"Daiki","family":"Saito","sequence":"first","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eizo","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan."},{"name":"Department of Emergency and Critical Care Medicine, Eastern Chiba Medical Center, Togane, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Ashida","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Osaka Medical College, Osaka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoko","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Endocrinology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaomi","family":"Nangaku","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Endocrinology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasufumi","family":"Ohtsuka","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiyuki","family":"Miyata","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriyuki","family":"Hattori","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeto","family":"Oda","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230728","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1056\/NEJMra0902814","article-title":"Atypical hemolytic-uremic syndrome.","volume":"361","author":"Noris","year":"2009","journal-title":"N Engl J Med"},{"key":"R2-20230728","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1186\/s13054-018-2073-2","article-title":"Thrombocytopenia in 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