Safe and effective use of eculizumab in the treatment of severe Shiga toxin Escherichia coli-associated hemolytic uremic syndrome.

PURPOSE: A severe case of Shiga toxin Escherichia coli (STEC)-associated hemolytic uremic syndrome (HUS) successfully treated with eculizumab is reported.

SUMMARY: An 18-year-old man was admitted to the intensive care unit with HUS due to laboratory-confirmed STEC O121. He was initially treated with plasmapheresis and required hemodialysis for anuric acute kidney injury. Plasmapheresis was stopped due to complications. He continued to show evidence of ongoing hemolysis and kidney injury. Due to the lack of clinical improvement in renal function and hematologic status as well as the severity of the patient's symptoms, the decision was made to initiate eculizumab. The patient was given i.v. eculizumab 900 mg infused over 35 minutes weekly for four weeks, followed by 1200 mg infused over 35 minutes one week later as the fifth dose and then every two weeks thereafter. The patient also received i.v. ciprofloxacin 400 mg infused over 60 minutes once every 24 hours for meningococcal prophylaxis and bacterial eradication. After initiation of eculizumab, the patient's platelet count rapidly improved. After three doses of eculizumab, the patient's renal function improved, and further hemodialysis was no longer required. The patient continued to receive twice-monthly eculizumab infusions to complete a two-month treatment course (seven doses), at which point his renal function returned to baseline. The initial two infusions were administered as an inpatient, and the remainder was infused in the outpatient setting.

CONCLUSION: An 18-year-old man who developed severe HUS due to STEC O121 and was unresponsive to traditional supportive therapies was successfully treated with eculizumab.