Unexpected childhood death due to hemolytic uremic syndrome

Two cases of unexpected childhood death due to he molytic uremic syndrome a re reported. A 21-month-old girl who was discovered dead in bed following a short illness was found at autopsy to have overwhelming sepsis resulting f rom transmural colitis. Escherichia coli serotype 0157A was isolated from t he intestine, and renal changes of hemolytic uremic syndrome were found. A 4-year-old girl died suddenly in hospital from intracranial hemorrhage whil e being treated for hemolytic uremic syndrome-related renal failure. Cultur e of urine and feces grew verocytotoxin producing E. coli. These cases demo nstrate that hemolytic uremic syndrome may be a rare cause of unexpected ch ildhood death and that the diagnosis may not be established prior to autops y. Postmortem culture of tissues and fluids in cases of suspected sepsis in children may be essential in establishing this diagnosis, because histolog ic evaluation may be compromised by profound sepsis and tissue putrefaction . Accuracy in diagnosis may have significant public health and medicolegal consequences.