Cholestatic jaundice in the haemolytic-uraemic syndrome: a case report

SUMMARY The haemolytic-uraemic syndrome is the term used to describe the symptom complex of acute oliguric renal failure, haemolysis, and thrombocytopaenia. The pathogenesis of the syndrome is unknown though several factors have been postulated as important. Gastrointestinal disease is now recognised as a regular feature of the syndrome but hepatic involvement is uncommon and limited to occasional jaundice, hepatosplenomegaly and rises in serum transaminase values. A patient is described in whom cholestatic jaundice occurred during the prodromal illness. Its presence is unexplained but might indicate infection with an unrecognised hepatotropic agent or else lack of enteral nutrition during the prodromal phase. The haemolytic-uraemic syndrome is a disorder, predominantly of young children, in which patients present with acute oliguric renal failure, haemo-lytic anaemia and thrombocytopaenia. ' 2 In most cases no causative agent is recognised though infection with certain viruses3 and Gram-negative enteric or anisms,4 5 the taking of oestrogens,6 pregnancy and the postpartum period8 have all been associated with the syndrome. The patho-genesis of the condition remains uncertain but recently genetic factors,9-12 deficiencies of prosta-cyclin, D 14 antithrombin III or vitamin E,9 15 the presence of circulating neuraminadase or endo-toxin,'S'8 and reduced in vitro platelet aggrega-tion10 13 14 have all been implicated. The onset of haemolytic-uraemic syndrome is usually preceded by a prodromal illness during which gastrointestinal symptoms, such as diarrhoea with or without bloody stools, vomiting and abdominal pain, commonly occur.1 19 20 It has been suggested recently that these symptoms may be signs of intestinal involvement in this syndrome and that intestinal disease is a regular feature of this condition.2 Hepatic complications of the syndrome have also been reported20 21 but ar