{
  "abstract": "Atypical hemolytic uremic syndrome (aHUS) represents a complement-mediated thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end-organ damage, most frequently affecting the kidneys. Although infection is a well-recognized precipitant, extensive skin involvement is uncommon. Here, we describe a 14-year-old boy who developed aHUS following Rhinovirus/Enterovirus infection. He was found to have anemia, thrombocytopenia, acute kidney injury, hematuria, and proteinuria, and peripheral smear examination demonstrated schistocytes. Complement evaluation showed reduced C3 and factor I concentrations, increased soluble C5b-9, and preserved ADAMTS13 activity. Investigations for Shiga toxin-producing Escherichia coli, systemic autoimmune disease, and alternative infectious etiologies were negative. Even with eculizumab, corticosteroids, therapeutic plasma exchange (TPE), and continuous renal replacement therapy (CRRT), his condition progressed to petechiae, ecchymoses, hemorrhagic bullae, and necrotic lesions of the axilla, neck, and back. Since the necrotic areas failed to heal and were accompanied by continued platelet consumption and a heightened risk of infection, surgical debridement and wound closure were undertaken after the platelet count reached 81 × 10^9/L. Histopathologic analysis of the excised tissue confirmed cutaneous thrombotic microangiopathy with microvascular thrombosis. Following the procedure, platelet count, hemoglobin, and complement C3 returned to normal, and the wound healed without complication. At subsequent follow-up, the scars were supple and level, with no sensory deficit or functional limitation. This report expands the range of infectious triggers associated with aHUS and demonstrates that persistent necrotic cutaneous thrombotic microangiopathy may necessitate prompt surgical management in addition to complement inhibition and supportive treatment.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Nephrology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University , ,",
    "Department of Burns and Plastic Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University , ,",
    "Department of Pathology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University , ,",
    "Department of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University , ,"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jiayao Shen"
    },
    {
      "affs": [
        1
      ],
      "name": "Kaixuan Cai"
    },
    {
      "affs": [
        0
      ],
      "name": "Weijie Kang"
    },
    {
      "affs": [
        2
      ],
      "name": "Qiao He"
    },
    {
      "affs": [
        3
      ],
      "name": "Jian Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Lei Yin"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3a03wkgngbfcp.bib",
  "cited_by": 0,
  "doi": "10.3389/fped.2026.1973640",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724424/?tool=EBI",
  "id": "3a03wkgngbfcp",
  "issns": [
    "2296-2360"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13724424",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2403|Complement system in diseases"
    ]
  ],
  "openalex": "W7222934362",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724424/pdf/?tool=EBI",
  "pmcid": "PMC13724424",
  "pmid": "42973488",
  "published": "2026-10-19",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/3a03wkgngbfcp.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:51Z",
      "native_id": "PMC:PMC13724424",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13724424"
    },
    {
      "first_seen": "2026-11-04T12:23:00Z",
      "native_id": "PMC13724424",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fped.2026.1973640"
    },
    {
      "first_seen": "2026-11-04T15:20:48Z",
      "native_id": "MED:42973488",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42973488"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "openalex:2403|Complement system in diseases",
      "subfield": "immunology"
    }
  ],
  "title": "Case Report: Atypical hemolytic uremic syndrome triggered by Rhinovirus/Enterovirus infection with cutaneous thrombotic microangiopathy requiring surgical management",
  "title_text": "Case Report: Atypical hemolytic uremic syndrome triggered by Rhinovirus/Enterovirus infection with cutaneous thrombotic microangiopathy requiring surgical management",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:20:54Z",
  "url": "https://research.draconitic.com/paper/3a03wkgngbfcp",
  "venue": "Frontiers in pediatrics",
  "versions": []
}