Atypical Hemolytic Uremic Syndrome After Post-Abortion Infection: Case Report and Literature Review.

BACKGROUND

The atypical hemolytic uremic syndrome (aHUS) presents diagnostic and therapeutic challenges due to overlapping features with other conditions like Preeclampsia/HELLP syndrome and thrombotic thrombocytopenic purpura (TTP). Pregnancy-associated aHUS is rare but carries a high risk of end-stage renal disease without prompt intervention.

CASE PRESENTATION: A 41-year-old female developed severe abdominal pain, acute kidney injury, and microangiopathic hemolysis following a surgical abortion five days ago. Laboratory findings revealed thrombocytopenia, schistocytes, elevated lactate dehydrogenase, and creatinine. Fragmented red blood cells were observed in the peripheral blood smear. Infection and complement dysregulation were suspected triggers. Despite normal complement levels, aHUS was diagnosed. Continuous renal replacement therapy stabilized renal function, but eculizumab was declined due to cost constraints.

DISCUSSION: This case highlights aHUS triggered by early miscarriage and postoperative infection, supporting the "multiple-hit" hypothesis. Diagnostic challenges include distinguishing aHUS from other TMAs, particularly with normal complement levels. Early plasmapheresis and eculizumab are recommended, though economic barriers may limit treatment options. Therapeutic plasma exchange demonstrated efficacy in renal recovery despite the absence of targeted therapy.

CONCLUSION

This report expands the clinical spectrum of aHUS to include early pregnancy loss as a potential trigger. It underscores the importance of rapid diagnosis, multidisciplinary management, and the need for accessible therapies in resource-limited settings. Further research is needed to optimize diagnostic criteria and treatment protocols for abortion-associated aHUS.