Good Responses to Eculizumab in STEC-HUS

Patients in a French outbreak of hemolytic uremic syndrome (HUS) caused by Shiga toxin–secreting Escherichia coli (STEC) O104:H4 responded well to treatment with the anti-C5 monoclonal antibody eculizumab, according to a report in Nephrology Dialysis Transplantation.

The 2011 outbreak was caused by contaminated organic fenugreek sprouts served at a community meal with 169 participants. Of 24 patients with STEC gastroenteritis, 9 experienced HUS, with hemolytic anemia, low platelet count, and renal complications. The patients included one child; HUS developed a median of 6 days after the initial symptoms of gastroenteritis.

Laboratory findings included a median platelet count of 26 g/L, hemoglobin 6.6 g/dL, lactate dehydrogenase 1520 IU/L, and creatinine 152 µmol/L. All HUS patients also had hepatic complications; the pancreas was involved in five patients, the brain in three, and the heart in three. Two patients were given dialysis and one received mechanical ventilation.

In the first three patients, plasma exchange failed to increase platelet count. These and all subsequent patients were treated with eculizumab, starting up to 4 days after the development of HUS. Anti-C5 therapy led to good outcomes in all patients, with rapid improvement in laboratory abnormalities. Renal function recovered gradually. There were no serious renal sequelae and no serious adverse effects of eculizumab.

Early eculizumab therapy yielded good outcomes in this limited outbreak of HUS caused by STEC O104:H4. Although no firm conclusions can be drawn about the efficacy of eculizumab, platelet count increased within 3 days after treatment and normalized within 7 days. All patients regained normal kidney function by 10 weeks’ follow-up [Delmas Y, et al. Outbreak of Escherichia coli O104:H4 haemolytic uraemic syndrome in France: outcome with eculizumab. Nephrol Dial Transpl 2014; 29:565–572].

April 2014 (Vol. 6, Number 4)