Pneumococcal meningitis complicated with thrombotic microangiopathy in a pediatric patient: a case report

Background Thrombotic microangiopathy (TMA) is characterized by three hallmark features: microangiopathic hemolytic anemia, thrombocytopenia, and organ injury caused by microcirculatory impairment. Case presentation The patient was a 3-year-7-month-old boy who visited a previous hospital complaining of fever and was observed for acute upper respiratory tract infection. However, due to persistence of high fever, the patient revisited the previous hospital three days later, was hospitalized, and treated with antibiotics for bacterial meningitis. After admission, thrombocytopenia and hemolytic anemia progressed over time, and the patient was transferred to our hospital on the fourth day of hospitalization. Subsequently, he developed status epilepticus and was admitted to the intensive care unit (ICU). Blood tests performed at the time of transfer revealed hemolytic anemia with schistocytes, thrombocytopenia, and renal dysfunction. In addition, Streptococcus pneumoniae was isolated in blood and cerebrospinal fluid cultures performed at the previous hospital, and treatment was initiated for suspected Streptococcus pneumoniae -associated hemolytic uremic syndrome (SpHUS). On day 5, hemolytic anemia progressed, and the patient received two units of red blood cells. Despite receiving medication, the patient experienced status epilepticus and required tracheal intubation and mechanical ventilation. From day 6, no further progression of hemolytic anemia occurred, and thrombocytopenia and renal dysfunction improved over the course of treatment. With a reduced sedative dosage, no recurrences of seizures were observed. On day 10, the patient was extubated and discharged from the ICU, and on day 45, he was discharged home. Conclusion SpHUS has a different mechanism from other TMAs, and its treatment is unique, requiring consideration of the use of washed blood products and albumin preparations during blood transfusion and plasma exchange. Early recognition and treatment of SpHUS are crucial.