Eculizumab for Shiga‐toxin‐induced hemolytic uremic syndrome in adults with neurological involvement
Benjamin J. Lee,
Zhaohui Arter,
Jean Doh,
Shawn P. Griffin,
Pongthep Vittayawacharin,
Steven Atallah,
Kevin R. Shieh,
Minh‐Ha Tran,
Sonata Jodele,
Piyanuch Kongtim,
Stefan O. Ciurea
Affiliations
Benjamin J. Lee
Department of Pharmacy University of California Irvine Health Orange California USA
Zhaohui Arter
Department of Medicine Division of Hematology‐Oncology Chao Family Comprehensive Cancer Center University of California Irvine Health Orange California USA
Jean Doh
Department of Pharmacy University of California Irvine Health Orange California USA
Shawn P. Griffin
Department of Pharmacy University of California Irvine Health Orange California USA
Pongthep Vittayawacharin
Department of Medicine Division of Hematology‐Oncology Chao Family Comprehensive Cancer Center University of California Irvine Health Orange California USA
Steven Atallah
Department of Pharmacy University of California Irvine Health Orange California USA
Kevin R. Shieh
Department of Medicine Division of Hematology‐Oncology Chao Family Comprehensive Cancer Center University of California Irvine Health Orange California USA
Minh‐Ha Tran
Department of Pathology and Laboratory Medicine Division of Transfusion Medicine University of California Irvine Health Orange California USA
Sonata Jodele
Division of Bone Marrow Transplantation and Immune Deficiency Cancer and Blood Disease Institute Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
Piyanuch Kongtim
Department of Medicine Division of Hematology‐Oncology Chao Family Comprehensive Cancer Center University of California Irvine Health Orange California USA
Stefan O. Ciurea
Department of Medicine Division of Hematology‐Oncology Chao Family Comprehensive Cancer Center University of California Irvine Health Orange California USA
Abstract The role of eculizumab in treating Shiga‐toxin‐producing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) patients with neurological involvement remains unclear. We describe two distinctly different STEC‐HUS patients with neurologic involvement successfully managed with eculizumab, and perform a literature review of all published cases. Both patients had complete resolution of neurological symptoms after initiation of eculizumab. Eighty patients with STEC‐HUS treated with eculizumab were identified in the literature, 68.7% had complete resolution of neurological symptoms. Based on our experience and literature review, three prevailing themes were noted: 1) Early eculizumab administration optimized neurological outcomes, 2) Symptom resolution may not be immediate, neurological symptoms may initially worsen before improvement, and 3) Plasma exchange yielded no benefit. Early administration of eculizumab may reverse neurotoxicity in patients with STEC‐HUS.
