{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T03:43:52Z","timestamp":1793245432948,"version":"4.5.0"},"reference-count":34,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,7,3]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>A woman in her 40s with no medical history presented on hospital day #0 with 3 days of epigastric pain, nausea, vomiting and bloody diarrhoea. Initial blood work demonstrated acute kidney injury with metabolic acidosis with an elevated anion gap, thrombocytopenia, an elevated lactate dehydrogenase, and an undetectable haptoglobin. She was quickly diagnosed with haemolytic uraemic syndrome from Shiga toxin-producing O157:H7 <jats:italic>Escherichia coli<\/jats:italic>. Her microangiopathic haemolytic anaemia and renal failure progressively worsened and only improved after the initiation of eculizumab, a monoclonal antibody directed against complement component C5. We report a case of Shiga toxin-producing <jats:italic>E. coli<\/jats:italic>-haemolytic uraemia syndrome with a complement-mediated component.<\/jats:p>","DOI":"10.1136\/bcr-2023-256449","type":"journal-article","created":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T01:06:31Z","timestamp":1724375191000},"page":"e256449","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Successful application of eculizumab in typical haemolytic uraemic syndrome"],"prefix":"10.1136","volume":"17","clinical-trial-number":[{"clinical-trial-number":"nct02205541","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"isrctn89553116","registry":"10.18810\/isrctn"}],"author":[{"given":"Garo","family":"Hagopian","sequence":"first","affiliation":[{"name":"Internal Medicine, University of California Irvine Medical Center, Orange, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid","family":"Yazdanpanah","sequence":"additional","affiliation":[{"name":"Hematology\/Oncology, University of California Irvine Medical Center, Orange, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minh-Ha","family":"Tran","sequence":"additional","affiliation":[{"name":"Pathology, University of California Irvine Medical Center, Orange, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Lee","sequence":"additional","affiliation":[{"name":"Hematology\/Oncology, University of California Irvine Medical Center, Orange, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"2025082804050596000_17.8.e256449.1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-11-709865"},{"key":"2025082804050596000_17.8.e256449.2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/1744-9987.12763","article-title":"Atypical hemolytic-uremic syndrome: an update on pathophysiology","volume":"23","author":"Raina","year":"2019","journal-title":"Ther Apher Dial"},{"key":"2025082804050596000_17.8.e256449.3","unstructured":"Bhandari J , Sedhai YR . Hemolytic uremic syndrome. In: StatPearls, Copyright \u00a9 2022, StatPearls Publishing LLC. Treasure Island (FL): StatPearls Publishing, 2022."},{"key":"2025082804050596000_17.8.e256449.4","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1038\/358167a0","article-title":"Shigella flexneri induces apoptosis in infected macrophages","volume":"358","author":"Zychlinsky","year":"1992","journal-title":"Nature New Biol"},{"key":"2025082804050596000_17.8.e256449.5","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1093\/ckj\/sfz040","article-title":"An updated classification of thrombotic microangiopathies and treatment of complement gene variant-mediated thrombotic microangiopathy","volume":"12","author":"Aigner","year":"2019","journal-title":"Clin Kidney J"},{"key":"2025082804050596000_17.8.e256449.6","doi-asserted-by":"crossref","DOI":"10.3389\/fcimb.2020.00169","article-title":"Treatment strategies for infections with Shiga toxin-producing escherichia coli","volume":"10","author":"M\u00fchlen","year":"2020","journal-title":"Front Cell Infect Microbiol"},{"key":"2025082804050596000_17.8.e256449.7","first-page":"587","article-title":"Ravulizumab: a review in atypical Haemolytic uraemic syndrome","volume":"81","author":"Syed","year":"2021","journal-title":"Drugs (Abingdon Engl)"},{"key":"2025082804050596000_17.8.e256449.8","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.thromres.2020.09.012","article-title":"Validation of the PLASMIC score for predicting ADAMTS13 activity <10% in patients with suspected thrombotic thrombocytopenic purpura in Alberta, Canada","volume":"196","author":"Wynick","year":"2020","journal-title":"Thromb Res"},{"key":"2025082804050596000_17.8.e256449.9","doi-asserted-by":"publisher","DOI":"10.1097\/01.md.0000133622.03370.07"},{"key":"2025082804050596000_17.8.e256449.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0010208","article-title":"Predictive features of severe acquired ADAMTS13 deficiency in idiopathic thrombotic microangiopathies: the French TMA reference center experience","volume":"5","author":"Coppo","year":"2010","journal-title":"PLoS ONE"},{"key":"2025082804050596000_17.8.e256449.11","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-09-243790"},{"key":"2025082804050596000_17.8.e256449.12","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-11-516237"},{"key":"2025082804050596000_17.8.e256449.13","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.thromres.2022.08.017","article-title":"Prognostic value of von Willebrand factor and ADAMTS13 in patients with COVID-19: a systematic review and meta-analysis","volume":"218","author":"Xu","year":"2022","journal-title":"Thromb Res"},{"key":"2025082804050596000_17.8.e256449.14","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000284508.05247.B3"},{"key":"2025082804050596000_17.8.e256449.15","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1097\/SHK.0000000000000341","article-title":"ADAMTS-13 in critically ill patients with septic syndromes and Noninfectious systemic inflammatory response syndrome","volume":"43","author":"Aibar","year":"2015","journal-title":"Shock"},{"key":"2025082804050596000_17.8.e256449.16","first-page":"168","article-title":"The complement system in hemolytic-uremic syndrome in childhood","volume":"13","author":"Monnens","year":"1980","journal-title":"Clin Nephrol"},{"key":"2025082804050596000_17.8.e256449.17","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02730409"},{"key":"2025082804050596000_17.8.e256449.18","doi-asserted-by":"crossref","unstructured":"Mahat U , Matar RB , Rotz SJ . Use of complement monoclonal antibody eculizumab in Shiga toxin producing Escherichia coli associated hemolytic uremic syndrome: a review of current evidence. Pediatr Blood Cancer 2019;66. doi:10.1002\/pbc.27913","DOI":"10.1002\/pbc.27913"},{"key":"2025082804050596000_17.8.e256449.19","unstructured":"National Center for Biotechnology Information . Clinvar; [VCV000092527.8]. Available: https:\/\/www.ncbi.nlm.nih.gov\/clinvar\/variation\/VCV000092527.8 [Accessed 17 Mar 2023]."},{"key":"2025082804050596000_17.8.e256449.20","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2013050453"},{"key":"2025082804050596000_17.8.e256449.21","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.hkjn.2014.07.001","article-title":"Renal outcome with eculizumab in two diarrhea-associated hemolytic\u2013uremic syndrome cases with severe neurologic involvement","volume":"16","author":"Ekinci","year":"2014","journal-title":"Hong Kong J Nephrol"},{"key":"2025082804050596000_17.8.e256449.22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1100859"},{"key":"2025082804050596000_17.8.e256449.23","doi-asserted-by":"publisher","DOI":"10.1177\/0009922814534520"},{"key":"2025082804050596000_17.8.e256449.24","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000001000","article-title":"Eculizumab in typical Hemolytic Uremic Syndrome (HUS) with neurological involvement","volume":"94","author":"Pape","year":"2015","journal-title":"Medicine (Balt)"},{"key":"2025082804050596000_17.8.e256449.25","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis531"},{"key":"2025082804050596000_17.8.e256449.26","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1093\/cid\/cix218","article-title":"Intermediate follow-up of pediatric patients with hemolytic uremic syndrome during the 2011 outbreak caused by E. coli O104:H4","volume":"64","author":"Loos","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2025082804050596000_17.8.e256449.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e4565","article-title":"Validation of treatment strategies for enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome: case-control study","volume":"345","author":"Menne","year":"2012","journal-title":"BMJ"},{"key":"2025082804050596000_17.8.e256449.28","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30062-4"},{"key":"2025082804050596000_17.8.e256449.29","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis531"},{"key":"2025082804050596000_17.8.e256449.30","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61145-8"},{"key":"2025082804050596000_17.8.e256449.31","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)01251-9"},{"key":"2025082804050596000_17.8.e256449.32","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1111\/1744-9987.12768","article-title":"Is plasma exchange efficacious in Shiga toxin-associated hemolytic uremic syndrome","volume":"23","author":"Keenswijk","year":"2019","journal-title":"Ther Apher Dial"},{"key":"2025082804050596000_17.8.e256449.33","doi-asserted-by":"publisher","DOI":"10.1002\/jca.22043"},{"key":"2025082804050596000_17.8.e256449.34","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1007\/s00467-018-4025-0","article-title":"Eculizumab in the treatment of Shiga toxin Haemolytic uraemic syndrome","volume":"34","author":"Walsh","year":"2019","journal-title":"Pediatr Nephrol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-256449","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:05:18Z","timestamp":1756379118000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-256449"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,22]]},"published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1136\/bcr-2023-256449"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-256449","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8]]}}}