A case report of a child with sepsis induced multiorgan failure and massive complement consumption treated with a short course of Eculizumab: A case of crosstalk between coagulation and complement?

Abstract:

RATIONALE:This article describes a child with a life-threatening multiorgan failure with disseminated intravascular coagulation (DIC) and massive complement consumption. To our knowledge this therapeutic approach was for the first time effectively applied in a pediatric patient. PATIENT CONCERNS:A 14-month-old boy was presented with a severe, rapidly progressing, life-threatening disease because of sudden onset of fever, hemathemesis, hematuria, and bloody diarrhoea alongside fast spreading hematomas and general corporeal edema. DIAGNOSIS:The most plausible diagnosis in our patient is Clostridium difficile sepsis-induced thrombotic microangiopathy alongside with DIC and consumption coagulopathy. The diagnosis was confirmed by positive C difficile bacteria strain in coproculture, clinical, and laboratory tests affirming DIC and global complement activation and consumption. INTERVENTIONS:The patient was treated with antibiotics (Metronidazole, Vancomycin), plasmapheresis, dialysis, methylprednisolone, mycophenolate mofetil, and Eculizumab. OUTCOMES:The child is in fair overall condition in a 2 year follow-up with no complications save chronic renal failure. LESSONS:In rare cases of sepsis with massive complement consumption, a case-sensitive Eculizumab therapy may be at least considered after the resolution of life-threatening multiorgan failure. The application of this drug can be performed only after sepsis induced disease is put under control. A fast withdrawal of Eculizumab after control of massive complement consumption is recommended to prevent triggering of second sepsis reactivation.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Galic S,Csuka D,Prohászka Z,Turudic D,Dzepina P,Milosevic D

doi

10.1097/MD.0000000000014105

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

e14105

issue

4

eissn

0025-7974

issn

1536-5964

pii

00005792-201901250-00020

journal_volume

98

pub_type

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