{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T09:49:05Z","timestamp":1791798545168,"version":"4.3.4"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":284,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Hematology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    A middle\u2010aged man presented with myalgia, fever, hematemesis, and melena. He was found to have acute kidney injury, acute coronary syndrome, thrombocytopenia, and Coombs\u2010negative hemolytic anemia, raising concern for thrombotic microangiopathy (TMA). While awaiting confirmatory testing, empirical plasma exchange was initiated. Initially, minimal red blood cell fragmentation was observed, which later progressed to florid fragmentation. Despite supportive care, his clinical status deteriorated requiring hemodialysis. The presence of TMA, along with\n                    <jats:italic>ADAMTS13<\/jats:italic>\n                    metalloprotease activity above the diagnostic threshold, worsening kidney function, and negative stool Shiga toxin testing suggested complement\u2010mediated TMA (C\u2010TMA). Stool PCR testing revealed rotavirus. Eculizumab was initiated, resulting in rapid normalization of hematological parameters and eventual renal recovery. Genetic testing identified a heterozygous\n                    <jats:italic>PLG<\/jats:italic>\n                    c.1735G\u2009&gt;\u2009A (p.Gly579Arg) variant classified as a variant of uncertain significance (VUS). The importance of serial review of peripheral blood smears and the diagnostic challenge of differentiating TTP, STEC\u2010HUS, and C\u2010TMA are the key learning points.\n                  <\/jats:p>","DOI":"10.1155\/crh\/1318626","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T09:22:38Z","timestamp":1791796958000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Excellent Response to Eculizumab in a Patient With Complement\u2010Mediated Thrombotic Microangiopathy and a Novel Plasminogen Gene Variant"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1477-5955","authenticated-orcid":false,"given":"Aman","family":"Patel","sequence":"first","affiliation":[{"name":"Mercer University School of Medicine  Columbus Georgia USA  mercer.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3198-2441","authenticated-orcid":false,"given":"Bowen","family":"Powers","sequence":"additional","affiliation":[{"name":"Mercer University School of Medicine  Columbus Georgia USA  mercer.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6294-0245","authenticated-orcid":false,"given":"Jason","family":"Tsai","sequence":"additional","affiliation":[{"name":"Nephrology Associates of Columbus  Columbus Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9115-4923","authenticated-orcid":false,"given":"Suresh","family":"Nukala","sequence":"additional","affiliation":[{"name":"Piedmont Columbus Midtown Hospital  Columbus Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-11-709865"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13571"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2016.1.217"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03520170059036"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(17)30062-4"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/toxins12020067"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.08921209"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms7010015"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.3390\/toxins15010010"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2004.02.010"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(22)01202-8"},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2024.05.021"},{"key":"e_1_2_12_13_2","article-title":"Pediatric Hemolytic Uremic Syndrome Related to STEC, France 2007\u20132016","volume":"24","author":"Bruyand M.","year":"2019","journal-title":"Euro Surveillance"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-015-3076-8"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-012-2131-y"},{"key":"e_1_2_12_16_2","doi-asserted-by":"publisher","DOI":"10.2215\/cjn.02210310"},{"key":"e_1_2_12_17_2","doi-asserted-by":"crossref","first-page":"591","DOI":"10.2215\/CJN.03270906","article-title":"Screening for Complement System Abnormalities in Patients With aHUS","volume":"2","author":"Kavanagh D.","year":"2007","journal-title":"Clinical Journal of the American Society of Nephrology"},{"key":"e_1_2_12_18_2","doi-asserted-by":"publisher","DOI":"10.2147\/clep.s245642"},{"key":"e_1_2_12_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2009.07916.x"},{"key":"e_1_2_12_20_2","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.hoc.2015.02.002","article-title":"Thrombotic Microangiopathy: Focus on Atypical Hemolytic Uremic Syndrome","volume":"29","author":"Sperati C. 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