An unusual case of haemolytic uraemic syndrome following endoscopic retro- grade cholangiopancreatography rapidly improved with eculizumab

Atypical haemolytic uraemic syndrome (aHUS) is a rare but life- threatening complement system-related disorder, characterized by renal failure, non-immune haemolytic anaemia and thrombo- cytopenia. We report on a young woman who developed a pancre- atitis-induced aHUS following a routine procedure of endoscopic retrograde cholangiopancreatography. The patient was succes- sively treated by 2 plasma exchanges with fresh frozen plasma and eculizumab, a monoclonal antibody designed to block terminal complement activation. The last treatment resulted in the immedi- ate improvement of haemolytic parameters and to the definitive suspension of plasma exchanges. This is likely the first description of the use of a complement inhibitor to treat post-pancreatitis aHUS. We discussed treatment options and concluded that eculi- zumab could be a beneficial alternative to plasma exchanges in the management of such complications. (Acta gastroenterol. belg., 2016, 79, 257-261).