RT Journal Article SR Electronic T1 Atypical haemolytic uremic syndrome from multiple missenses to a full-blown disease JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e230026 DO 10.1136/bcr-2019-230026 VO 12 IS 6 A1 Filipe Santos Mira A1 Ana LuĂ­sa Nunes A1 Ana Rita Elvas A1 Nuno Oliveira YR 2019 UL http://casereports.bmj.com/content/12/6/e230026.abstract AB A 72-year-old woman was admitted to the hospital because of dorsal, lumbar and lower abdomen pain that had started 4 days before. She had a history of age-related macular degeneration (treated with intraocular bevacizumab). Blood tests showed anaemia, thrombocytopaenia, acute kidney injury, elevated liver enzymes and total bilirubin (mainly because of the indirect fraction). Viral serologies and ADAMTS13 activity levels were normal, and stool testing was negative for Escherichia coli-producing Shiga toxins. E. coli was isolated in urine. Atypical haemolytic uremic syndrome triggered by a urinary tract infection or by the vascular endothelial growth factor-inhibitor bevacizumab were the most likely hypothesis. The patient started urgent plasmapheresis and dialysis that lasted for a total of 18 days. There was complete remission and recovery of kidney function allowing for treatment discontinuation, and she was discharged home. After 6 months of follow-up, she shows no signs of relapse.