Pneumococcal pneumonia with empyema and hemolytic uremic syndrome in children: report of three cases

Streptococcus pneumoniae is an uncommon etiological organism in children with hemolytic uremic syndrome (HUS). Patients with S. pneumoniae-associated HUS commonly have a pneumonia or meningitis. Historically, S. pneumoniae-associated HUS usually has a poor clinical outcome. We report 3 pediatric cases of pneumococcal pneumonia-induced HUS. All 3 patients were2 years old, had an empyema complicating pneumococcal pneumonia, and developed renal failure with oliguria and required peritoneal dialysis for a period of 9 to 26 days. All children received several transfusions of unwashed packed red cells and platelets. All of the patients survived. Of the 3 cases, 2 had a normal renal function at discharge, and 1 had a mild renal impairment at 16-month follow-up. Our report suggests S. pneumoniae-associated HUS remains a rare but severe complication of invasive pneumococcal infection in children. It is important for pediatricians to note that children with pneumococcal pneumonia with severe hematologic and renal dysfunction should be investigated for evidence of S. pneumoniae-associated HUS.