Complement activation: an atypical presentation of an atypical syndrome

Alfredo Iardino, Viviane Bunin, Luan D. Truong, Hector Alejandro Preti

Research output: Contribution to journalArticlepeer-review


A 42-year-old Hispanic female and long-distance runner was seen for evaluation of fatigue. Her physical examination showed petechiae and ecchymoses in upper extremities, abdominal distension and bilateral ankle oedema. Laboratory workup revealed anaemia, thrombocytopenia, hypoalbuminemia and proteinuria of 1.4 g/24 hours. No schistocytes were found on peripheral blood smear. CT of her abdomen revealed diffuse small lymphadenopathy and hepatomegaly. Bone marrow biopsy demonstrated normal trilineage hematopoiesis with no hemophagocytosis. The patient was started on oral prednisone with no improvement and was subsequently admitted to the hospital for pulsed steroids, intravenous immunoglobulin and rituximab. Her proteinuria became nephrotic range, and a renal biopsy revealed features of thrombotic microangiopathy limited to the glomerular capillaries. ADAMTS13 was low which is >10% of normal, and a diagnosis of atypical haemolytic-uraemic syndrome (aHUS) was made. Eculizumab was started with prompt response. Whole exome sequencing demonstrated mutation in SPTA1, which has been associated with red blood cell membrane diseases but has not been described in patients with aHUS.

Original languageEnglish (US)
JournalBMJ Case Reports
StatePublished - Oct 30 2017


  • acute renal failure
  • haematology (drugs and medicines)
  • malignant and benign haematology
  • nephrotic syndrome
  • proteinurea

ASJC Scopus subject areas

  • Medicine(all)


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