Hemorrhagic colitis with Escherichia coli O157:H7 preceding adult hemolytic uremic syndrome

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Abstract
Escherichia coli serotype 0157:H7 is a rarely identified organism that has recently been associated with hemorrhagic colitis in all age groups and with the hemolytic uremic syndrome (HUS) in children. We now report the development of HUS in two young women following enteric infection with E. coli 0157:H7. Both patients were hospitalized because of the severity of their colitis. They later developed major hemolysis requiring transfusion and significant renal failure requiring, in one case, hemodialysis. One patient underwent laparotomy, where sterile ascites, marked right colonic edema, and intraserosal hemorrhage were noted. Both women survived and are currently improving. Fecal E. coli serotype 0157:H7 was sought only after routine cultures were negative and features of HUS were recognized. The search for the E. coli was facilitated by the continued availability of stool cultures obtained early in the course of the illness. The source of infection was not ascertained, but ingestion of untreated water was a feature of both cases. The HUS is a potential complication of the hemorrhagic colitis associated with E. coli serotype 0157:H7 and may develop in adults as well as children following enteric infection with this organism.