Article in Japanese

A 5-year-old boy with hemolytic uremic syndrome due to enterohemorrhagic Escherichia coli O157 infection complicated by a hemorrhagic cerebral infarction: A case report

Yohei Minamikawa^{1）, 3）}, Yasuko Okumura^1）, Akihiro Kida^1）, Koichi Tanda^1）, Nozomi Kozan^1）, Soichiro Numa^2）, Takehiro Yamada^2）, Keisuke Imai^2）, Masashi Nishida^{1）, 4）}

Approximately 20％ of patients with hemolytic uremic syndrome （HUS） caused by enterohemorrhagic Escherichia coli （EHEC） infection develop central nervous system complications. Stroke is a rare complication in children with HUS, and its prognosis is often poor due to the lack of standardized treatments. We report a case of a boy who developed a stroke after HUS, which was difficult to treat.
A 5-year-old healthy boy developed HUS due to EHEC O157 infection. On Day 10 of admission, after treatment with diuretics, thrombomodulin, and transfusions of concentrated red blood cells, he developed right facial palsy, weakness of the right arm and leg, and motor aphasia. Magnetic resonance imaging/magnetic resonance angiography showed occlusion of the left internal carotid artery and cerebral infarction in the left frontal lobe and basal ganglia. He was treated with non-invasive procedures such as targeted temperature management,citicoline,and antiepileptic drug administration. During treatment, his D-dimer levels were elevated due to SARS-CoV-2 infection, and heparin was administered continuously. On Day 33 of admission, we initiated thyrotropin-releasing hormone （TRH） therapy was initiated for neurological recovery, along with oral aspirin for elevated platelet counts, and with these treatments in parallel with rehabilitation, the neurological symptoms improved.
In patients with HUS,cerebral infarction can occur at any stage from the acute to the convalescent phase.When new neurological findings appear,the possibility of cerebral infarction should be considered,and treatment adjusted accordingly.

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1）Department of Pediatrics, Japanese Red Cross Society Kyoto Daiichi Hospital
2）Department of Neurology, Japanese Red Cross Society Kyoto Daiichi Hospital
3）Department of Pediatrics, Matsushita Memorial Hospital
4）Hananoki Medical and Welfare Center

Key words
Received	August 25, 2024
Accepted	March 23, 2025

37 (2)：177─183,2025