ARTICLE TYPE : CASE REPORT
Published on : 19 Feb 2026, Volume - 2
Journal Title :
WebLog Journal of Immunology | WebLog J Immunol
Source URL: 
https://weblogoa.com/articles/wji.2026.b1901
Permanent Identifier (DOI) : 
https://doi.org/10.5281/zenodo.18820075
De Novo Infection‑Associated Complement‑Mediated Hemolytic Uremic Syndrome in a Renal Transplant Recipient: A Complex Diagnostic Journey
2Lincoln University College, 2, Jalan Stadium, SS7/15 SS7. 47301 Petaling Jaya, Selangor, Malaysia
3Formerly Head, Department of Surgery at Tata Memorial Hospital, Mumbai, India
4J. Watumull Global Hospital & Research Centre, Delwara Road, Mount Abu, Rajasthan, India
Abstract
A 71‑year‑old renal transplant recipient presented with progressive malaise, gastrointestinal symptoms, fever, anemia, and acute graft dysfunction following recent travel abroad. Initial investigations revealed Micro‑Angiopathic Hemolytic Anemia (MAHA), thrombocytosis evolving into relative thrombocytopenia, elevated inflammatory markers, and declining renal function. The diagnostic process was complicated by overlapping possibilities including infection, viral reactivation, drug toxicity, rejection, and Thrombotic Micro‑Angiopathy (TMA). Subsequent findings of Cytomegalovirus (CMV) viraemia, Escherichia coli urinary tract infection, and biopsy‑proven TMA ultimately supported a diagnosis of de novo infection‑associated, complement‑mediated Hemolytic Uremic Syndrome (HUS). The patient improved with targeted antimicrobial therapy, immunosuppression adjustment, and supportive care, though renal recovery remained incomplete. This case highlights the diagnostic complexity of TMA in transplant recipients and the importance of maintaining broad clinical suspicion when multiple triggers coexist. The patient received valganciclovir for CMV, intravenous co‑amoxiclav for E. coli pyelonephritis, fluid resuscitation, and temporary reduction of immunosuppression. Plasma exchange and complement‑targeted therapy were considered but deferred due to clinical improvement. Hematological parameters normalized, and renal function partially recovered, stabilizing at an eGFR of 38‑42 mL/min/1.73 m².
Keywords: Iga Nephropathy; End‑Stage Renal Failure; Cytomegalovirus; Renal Allograft; Escherichia Coli; Kidney Transplantation; De Novo Hemolytic Uremic Syndrome; T hrombotic Microangiopathy; Acute Diverticulitis; Pyelonephritis; Infection‑Triggered HUS; Complement‑Mediated Injury; Allograft Dysfunction; Microangiopathic Hemolytic Anemia; Tacrolimus Immunosuppression; Transplant Complications
Citation
Govani DR, Swamy KB, Mehta AR, Midha PK, Govani ND, Panchasara NG, et al. De Novo Infection-Associated Complement-Mediated Hemolytic Uremic Syndrome in a Renal Transplant Recipient: A Complex Diagnostic Journey. WebLog J Immunol. wji.2026. b1901. https://doi.org/10.5281/zenodo.18820075