ESPN 51th Annual Meeting

ESPN 2018


 
A CASE WITH TROMBOCYTOPENIA ASSOCIATED MULTIORGAN FAILURE (TAMOF) PRESENTING WITH PNEUMOCOCCAL MENINGITIS AND ACUTE RENAL FAILURE
NURAY ALPMAN 1 ŞAHIN SINCAR 2 EMINE AKKUZU 2 BURCU YAZICIOĞLU 1 GÖKHAN KALKAN 2 SEVCAN A. BAKKALOĞLU 1 NECLA BUYAN 1

1- GAZI UNIVERSITY, DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- GAZI UNIVERSITY, DEPARTMENT OF PEDIATRIC INTENSIVE CARE UNIT
 
Introduction:

 TAMOF is a microangiopathic disorder which includes new onset trombocytopenia, multiple organ failure, elevated LDH levels.Acute kidney injury (AKI) is a common feature in patients with TAMOF as microvascular thromboses lead to organ ischemia and dysfunction in all organs which increase the mortality.

Material and methods:

 Here we present a three year old girl who was admitted to PICU with a three day history of otitis, fever, headache and vomiting. There was no drug exposure.Her BP was130/90 mm Hg.She was lethargic.Physical exam revealed oropharyngeal hyperemia,mucosal dryness,moderately dehydration and neck stiffness.Her laboratory eveluation showed a Hb of 9.8 gr/dl ,plt of 67000 mm3, CRP of 181,urine protein (++),urine density of 1027. Her BUN was 6 mg/dl and creatinine was 0.38 mg/dl at onset. Doppler USG showed increased renal echogenity and patent renal vessels. As she was oligo-anuric for two weeks and creatinine reached to 4.4 mg/dl, GFR decreased to 9.5 mg /min/1.73m2, hemodialysis was started. Blood gases showed metabolic acidosis. LDH was 2399 U, AST:593 U, ,ALT:68 U, Total/direct biluribine:1.86/1.18 mg/dl.INR and cardiac enzymes were increased. Fibrinogen.C3,C4 were normal. Peripheral blood smear showed no hemolysis. Her ADAMSTS 13 level was normal. On spinal tap 100 WBCs with gr + cocci, ceftriaxone and vancomycine were started immediately. Cranial MR  demonstrated focal subdural empyema. Blood and spinal cultures were positive for pneumococcus. FFP was infused for platelet depletion.Additionally ,eight sessions of plasma exchange(PE)s were  performed. Her LDH level was decreased to 371 on the fourth week.She received CVVH for restoration of volume overload.Her creatinine was 1.7 mg/dl at discharge.Five months after onset,creatinine level was 1.07 mg/dl and GFR was 41 ml / min7 1.73 m2.

 

Results:

Conclusions:

 Prompt initiation of PEs and RRT and restoration of trombocytopenia play important roles on the outcome of this critical condition.