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Spizzirri AP, Cobeñas CJ, Alconcher LF, Murray N, Zarate C, Curutchet L, De Rose E, Gogorza MJ, Lucarelli L, Ruscasso J, Lombardi L, Pereyra P, Zalba J, Risso P, Suarez A. Ocular involvement in STEC-associated hemolytic uremic syndrome. Pediatr Nephrol 2022; 37:2699-2703. [PMID: 35524864 DOI: 10.1007/s00467-022-05587-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemolytic uremic syndrome (HUS) is a systemic thrombotic microangiopathy characterized by hemolytic anemia, thrombocytopenia, and variable kidney involvement. Extrarenal thrombotic microangiopathy occurs in central nervous system (CNS), colon, and other organ systems, but ocular involvement is rarely recognized. This study aimed to analyze frequency and severity of ocular involvement in STEC-HUS, and the relationship between ocular involvement and disease severity, with emphasis on CNS, kidney, and colonic disease. METHODS Prospective, longitudinal, observational study. INCLUSION CRITERIA STEC-HUS patients September 2014-January 2019. Funduscopic examination (FE) was performed within 48 h of admission. We evaluated severity of CNS disease, kidney involvement, and presence of hemorrhagic colitis (HC). RESULTS Ninety-nine patients were included (female 52), mean age 39.4 months (DE: 29.8; range 9-132). Thirteen patients (13.1%) had abnormal FE, 10 showing variable degrees of hemorrhagic exudates and 2 with typical Purtscher-like retinopathy. Other findings included tortuous vascularity, cotton wool spots, and transient retinal edema. CNS involvement was present in 16/99 patients, severe in 12 (75%). Abnormal FE occurred in 5/12 (31%) patients with severe CNS involvement vs. 8/87 (9.2%) with mild, moderate, or no CNS disease (p = 0.0191). Abnormal FE was present in 2/33 (6%) patients without dialysis vs. 11/66 (16.6%) requiring dialysis (p = 0.20). Finally, there were FE abnormalities in 6/20 patients with HC vs. 7/79 without HC (p = 0.012). CONCLUSIONS FE abnormalities were present in 13% of HUS patients. Abnormal FE significantly associated with more severe disease, including severe CNS involvement and HC. We suggest FE should be performed in severe HUS, especially in cases with severe CNS disease. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ana P Spizzirri
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina.
| | - Carlos J Cobeñas
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Laura F Alconcher
- Nephrology Unit, Hospital Interzonal General Dr. José Penna. Bahía Blanca, Buenos Aires, Argentina
| | - Néstor Murray
- Ophthalmology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Claudia Zarate
- Ophthalmology Department, Hospital Interzonal General Dr. José Penna, Bahía Blanca, Buenos Aires, Argentina
| | - Laura Curutchet
- Ophthalmology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Emanuel De Rose
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - María José Gogorza
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Lucas Lucarelli
- Nephrology Unit, Hospital Interzonal General Dr. José Penna. Bahía Blanca, Buenos Aires, Argentina
| | - Javier Ruscasso
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Laura Lombardi
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Priscila Pereyra
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Javier Zalba
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
| | - Paula Risso
- Cátedra de Bioestadística Bayesiana y Clásica, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata, Argentina
| | - Angela Suarez
- Nephrology Department, Hospital de Niños "Superiora Sor María Ludovica", LaPlata, Buenos Aires, Argentina
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Thau A, Saffren B, Zakrzewski H, Anderst JD, Carpenter SL, Levin A. Retinal hemorrhage and bleeding disorders in children: A review. CHILD ABUSE & NEGLECT 2021; 112:104901. [PMID: 33401159 DOI: 10.1016/j.chiabu.2020.104901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Retinal hemorrhages (RH) are a common manifestation of abusive head trauma (AHT) resulting from acceleration-deceleration injury with or without blunt impact. Evaluation of a child with RH requires careful consideration of these differential diagnoses. The extent to which coagulopathy alone can cause RH would be useful to understand as coagulopathy may accompany AHT. OBJECTIVE In this systematic review, we sought to identify whether coagulopathies have been reported with RH similar to those of AHT. METHODS We performed a literature search for ocular manifestations of bleeding disorders in children less than 18 years old. We included clotting factor deficiencies, vitamin K deficiency, platelet function abnormalities, thrombocytopenia, disseminated intravascular coagulation (DIC), and trauma induced coagulopathy (TIC). We included only pediatric reports of intraocular bleeding or documented eye examinations that indicated no hemorrhages. We then re-examined cases for ocular and systemic findings that could potentially mimic abuse. RESULTS Our initial search yielded 816 results. Sixty-one articles met our inclusion criteria. Of these, there were 32 children within the AHT age range (less than 5 years old) who had RH and concomitant coagulopathy. Only 5 cases might potentially be confused for abuse. Of these, no classic characteristics of RH from abuse such as retinoschisis or retinal folds were found. Systemic features were inconsistent with AHT. CONCLUSIONS The presence of coagulopathy alone does not rule out the possibility that the child has been abused. Coagulopathy alone has not been reported as an etiology of RH that are consistent with AHT, especially when other findings are present.
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Affiliation(s)
- Avrey Thau
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Brooke Saffren
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Helena Zakrzewski
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - James D Anderst
- Division of Child Adversity and Resilience, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shannon L Carpenter
- Department of Hematology, Oncology, and Bone Marrow Transplantation, Children's Mercy Hospital, Kansas City, MO, USA
| | - Alex Levin
- Flaum Eye Institute and Golisano Children's Hospital, University of Rochester, New York, USA.
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Sandhu H, Vavvas D. Bilateral tractional retinal detachment in a patient with hemolytic-uremic syndrome. J AAPOS 2015; 19:484-6. [PMID: 26486040 DOI: 10.1016/j.jaapos.2015.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 05/11/2015] [Accepted: 05/26/2015] [Indexed: 11/26/2022]
Abstract
Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy characterized by hemolytic anemia, acute kidney injury, and thrombocytopenia. Ophthalmic manifestations of HUS range from mild, including scattered intraretinal hemorrhages, to severe, including a Purtscher-like retinopathy and iris and optic disk neovascularization (NVD). We report the case of a 23-month-old girl with severe HUS who presented with bilateral dense vitreous hemorrhage. During vitrectomy, optic disk neovascularization and funnel-shaped, tractional detachments of both retinas were observed. To our knowledge, this is the first reported case of tractional retinal detachment in the context of HUS.
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Affiliation(s)
- Harpal Sandhu
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Medical School, Philadelphia, Pennsylvania.
| | - Demetrios Vavvas
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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