Faten Tinsa
Nesrine Ncibi
najla Ben JBALLAH
Ahmed Mehrezi


Background: Hemolytic uremic syndrome, one of the common causes of acute renal failure in children, is characterized by the triad of microangiopathy, haemolytic anemia, thrombocytopenia and acute renal failure. The diarrhoea-associated Hemolytic uremic syndrome is usually termed as a typical Hemolytic uremic  syndrome.
Streptococcus pneumoniae is an uncommon etiological pathogen for inducing Hemolytic uremic syndrome, and Streptococcus pneumoniae associated Hemolytic uremic syndrome is also termed as atypical hemolytic uremic syndrome.
Aim: to report two pediatric cases of invasive S pneumoniae complicated with hemolytic uremic syndrome HUS. Case report: The first patient presented with pneumococcal pneumonia and empyema and the second patient presented with pneumococcal pneumonia and meningitis. The two patients were under one year of age and required peritoneal dialysis with improvement of renal function in one; the other died.
Conclusion: Pneumococcal invasive disease may be a cause of severe HUS, so a high index of suspicion is mandatory to prompt appropriate diagnosis and management.


Empyema, Hemolytic-uremic syndrome, pneumonia, meningitis, streptococcus pneumoniae, children



  1. Denis F. Geary MB. Hemolytic Uremic Syndrome and Streptococcus Pneumoniae: Improving our Understanding. J Ped 2007; 151:113-114
  2. Waters AF, Kerecuk L, Luk D et al. Hemolytic Uremic Syndrome Associated with Invasive Pneumococcal Disease: The United Kingdom Experience. J Ped 2007; 151: 140-144
  3. Huang DT, Chi H, Lee HC, Chiu NC, Huang FY. T-antigen activation for prediction of pneumococcus-induced hemolytic uremic syndrome and hemolytic anemia: Pediatr Infect Dis J 2006; 7:608-10
  4. Cochran JB, Panzarino VM, Maes LY, Tecklenburg FW. Pneumococcus-induced T-antigen activation in hemolytic uremic syndrome and anemia. Pediatr Nephrol 2004; 3:317-21
  5. Ramasethu J, Luban N. T activation. Br J Heamatol 2001;112:259-63
  6. Chih-Fang L, Shu-Chih L, Ko-Huang L, Jung-Pin C, Ji-Nau S. Pneumococcal pneumonia with empyema and haemolytic uremic syndrome in children: report of three cases. J Microbiol Immunol Infect 2006; 39: 348-352
  7. Brandt J, Wong C, Mihm S, et al. Invasive Pneumococcal Disease and Hemolytic Uremic Syndrome. Pediatrics 2002; 110:371-37