Ka. Myers et Tj. Marrie, THROMBOTIC MICROANGIOPATHY ASSOCIATED WITH STREPTOCOCCUS-PNEUMONIAE BACTEREMIA - CASE-REPORT AND REVIEW, Clinical infectious diseases, 17(6), 1993, pp. 1037-1040
Thrombotic microangiopathy, a disease within the clinical spectrum of
thrombotic thrombocytopenic purpura and hemolytic-uremic syndrome, was
recognized in a previously healthy 50-year-old woman who presented wi
th pneumococcal bacteremia complicated by thrombocytopenia, microangio
pathic hemolytic anemia, renal failure, and disorientation. After trea
tment with plasma exchange and antibiotics, the patient's clinical con
dition improved. Discontinuation of plasma exchange resulted in a rela
pse of thrombocytopenia and microangiopathic hemolytic anemia that res
ponded to reinitiation of this intervention. The production of the enz
yme neuraminidase by Streptococcus pneumoniae is thought to contribute
to the pathogenesis of the thrombotic process. Although pneumococcal
infection has been associated with hemolytic-uremic syndrome in childr
en, review of the literature on adults revealed only one such case (in
a patient who had undergone splenectomy in the remote past). This rep
ort therefore documents an unusual complication of pneumococcal bacter
emia in an immunocompetent adult.