THE HEMOLYTIC-UREMIC SYNDROME PRESENTING AS BILATERAL LEG ISCHEMIA

The hemolytic uremic syndrome in adults is an uncommon clinical entity consisting of microangiopathic hemolytic anemia, thrombocytopenia, an d renal dysfunction. A previously healthy 42-year-old man, after a 2-d ay prodromal phase, developed severe pain and coldness in both legs, w ith purpura in the face and extremities. On admission, hepatorenal dys function and disseminated intravascular coagulation were evident. Thes e complicated signs and symptoms led to nonspecific supportive therapy because of delayed diagnosis. The patient's condition gradually impro ved except for ischemia of the legs, which progressed into symmetrical necrosis; eventually, bilateral below-knee amputation was required. T his is the first reported case of the hemolytic uremic syndrome compli cated by bilateral leg ischemia. A presumed cause of the ischemia was disseminated intravascular coagulation, a rare complication of the hem olytic uremic syndrome. (C) 1997 by W.B. Saunders Company.