Hemolytic-uremic syndrome associated with Streptococcus pneumoniae. Report of a case and review of the literature.

A child aged 2 years 3 months with Streptococcus pneumoniae sepsis and pulmonary abscesses had hemolytic-uremic syndrome and acute renal failure develop that required 36 cycles of peritoneal dialysis. A percutaneous renal biopsy specimen taken after dialysis showed mesangial proliferation with interposition, hemorrhagic crescents, and intracapillary thrombosis with fibrinogen and IgM deposition. The atrophic renal tubules showed positive immunofluorescence against peanut agglutinin. Neuraminidase released by pneumococcal organisms is thought to expose the Thomsen-Friedenreich antigen on platelets, erythrocytes, and kidneys, resulting in IgM deposition and binding of peanut agglutinin. Review of the literature showed four other reports involving five children who had hemolytic-uremic syndrome develop secondary to pneumococcal infections.