A 34-year-old woman develops microangiopathic haemolytic anaemia, thrombocytopenia of 18,000/mm3, and AKI with creatinine 3.9 mg/dL, 10 days after an episode of bloody diarrhoea. ADAMTS13 activity is 85 percent. Stool culture grows Escherichia coli O157:H7. Which therapy is contraindicated in her management?

• A Supportive care with fluid and electrolyte management
• B Plasma exchange
• C Dialysis if severe hyperkalaemia develops
• D Empirical antibiotics such as ciprofloxacin ✓

Explanation

This is Shiga toxin-associated haemolytic uraemic syndrome: diarrhoea prodrome, MAHA, thrombocytopenia, AKI, normal ADAMTS13 excluding TTP. Antibiotics are contraindicated because bacterial lysis increases Shiga toxin release and studies show they raise the risk of HUS in children with EHEC infection. Supportive care and dialysis for complications remain the mainstay. Plasma exchange is reserved for severe atypical HUS or diagnostic uncertainty, not routine STEC-HUS.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.