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Adult Shigatoxin-mediated hemolytic uremic syndrome masked by alcohol use and inflammatory bowel disease
  1. Rachel Thompson1,
  2. Lisa Peng2,
  3. Breanna Zarmbinski2 and
  4. David M Tierney2
  1. 1Medical School, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
  2. 2Graduate Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
  1. Correspondence to Dr David M Tierney; David.Tierney{at}


Diagnosing uncommon diseases in individuals with underlying medical conditions can be challenging. Cognitive bias can lead to delayed or missed disease management. We present a case of Shiga-toxin mediated hemolytic uremic syndrome (ST-HUS) in a 46-year-old man with ulcerative colitis and alcohol use disorder who presented with acute alcohol intoxication, non-bloody diarrhoea and coffee ground emesis. He was admitted to the hospital for alcoholic ketoacidosis, alcohol withdrawal and possible upper gastrointestinal bleed, but ultimately, he developed severe thrombocytopaenia, hemolytic anaemia, acute renal failure and prolonged altered mentation. Given that ST-HUS is uncommon in adults, his initial report of diarrhoea was attributed to alcohol use or underlying active ulcerative colitis and not connected to his haematologic abnormalities. He was initially started on plasmapheresis; however, thrombotic microangiopathy work up revealed Shiga-toxin in his stool and ADAMST13 levels within normal limits. Subsequently, he was transitioned to supportive care for management of ST-HUS.

  • infection (gastroenterology)
  • haematology (incl blood transfusion)
  • infectious diseases
  • foodborne infections
  • thrombotic thrombocytopenic purpura

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  • Contributors RT, LP, BZ and DMT have all contributed substantially to the conception and drafting of the manuscript. All authors have given final approval of the submitted version. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.