An unusual case of haemolytic uraemic syndrome following endoscopic retrograde cholangiopancreatography rapidly improved with eculizumab.

Atypical haemolytic uraemic syndrome (aHUS) is a rare but life-threatening complement system-related disorder, characterized by renal failure, non-immune haemolytic anaemia and thrombo-cytopenia. We report on a young woman who developed a pancreatitis-induced aHUS following a routine procedure of endoscopic retrograde cholangiopancreatography. The patient was successively treated by 2 plasma exchanges with fresh frozen plasma and eculizumab, a monoclonal antibody designed to block terminal complement activation. The last treatment resulted in the immediate improvement of haemolytic parameters and to the definitive suspension of plasma exchanges. This is likely the first description of the use of a complement inhibitor to treat post-pancreatitis aHUS. We discussed treatment options and concluded that eculizumab could be a beneficial alternative to plasma exchanges in the management of such complications.