Abstract:

Atypical hemolytic-uremic syndrome (aHUS) is a rare and life-threatening thrombotic microangiopathy (TMA) characterized by uncontrolled activation of the complement system's alternative pathway. In recent years, accumulating clinical evidence and case reports have established severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as a significant trigger for aHUS. This report describes a male patient with a prior history of hemolytic anemia associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency. He was admitted because of chest tightness and chest pain for two days. During hospitalization, he progressively developed typical features of aHUS, including microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). Concurrently, nucleic acid testing for SARS-CoV-2 yielded positive results. Based on the patient's medical history, clinical presentation, laboratory findings, and the exclusion of other causes of TMA, a diagnosis of SARS-CoV-2-induced aHUS was established. Following admission, the patient received a multimodal therapeutic regimen consisting of glucocorticoids, plasma exchange (PE), and eculizumab. With timely and standardized intervention, his condition was effectively controlled and remained stable. This case may provide a reference for the clinical diagnosis and management of SARS-CoV-2-associated aHUS, particularly in patients with a history of hemolytic disorders.

Key words: atypical hemolytic-uremic syndrome, thrombotic microangiopathy, plasma exchange, eculizumab, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)