Shiga Toxin—Producing Escherichia coli Urinary Tract Infection Associated with Hemolytic-Uremic Syndrome in an Adult and Possible Adverse Effect of Ofloxacin Therapy

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Abstract
The hemolytic-uremic syndrome (HUS) is a rare and serious disease. The condition predominates in young children and is frequently associated with an enteric infection due to serotype O157 Shiga toxin—producing Escherichia coli (STEC) [1]. Shiga toxins, namely STX1 and STX2, are thought to cause endothelial cell damage (primarily in the kidney) and consequent platelet aggregation. Shiga toxins can also be produced by non-O157 serotypes or Shigella dysenteriae [1]. Drugs, autoimmune disease, and neoplasms have been more particularly associated with thrombotic thrombocytopenic purpura (TTP), a closely related syndrome that occurs more frequently in adults and is associated with prominent neurological disorders. Various hypotheses have been proposed to explain the platelet aggregation disturbance that is observed in association with both HUS and TTP; the most recent hypothesis suggests a deficit of the von Willebrand factor—cleaving protease [2]. We report an unusual case of HUS in an adult patient with STEC urinary tract infection (UTI). We also suggest the possible adverse effect of antibiotics (and STX2) on HUS.