Peripheral gangrene complicating idiopathic and recessive hemolytic uremicsyndromes

Three patients with hemolytic uremic syndrome (HUS) developed peripheral ga ngrene. Bilateral carotid artery thromboses occurred in one of these patien ts after recovery from HUS. One patient had a long history of juvenile rheu matoid arthritis. In the second patient, a flu-like illness preceded the on set of HUS. The third was one of two sisters, with the HUS appearing mon th an 1 year apart. None had evidence of disseminated intravascular coagulatio n or infection with Streptococcus pneumoniae. The patient with rheumatoid a rthritis had renal cortical necrosis but recovered moderate renal function after treatment with dialysis and plasmapheresis for 6 months. The child wi th a genetic form of HUS died of renal failure and had massive cortical nec rosis and vascular thrombosis at autopsy. This is the first report of perip heral gangrene in children with idiopathic HUS and autosomal recessive HUS.