# Successful Management of Atypical Hemolytic-Uremic Syndrome in Pregnancy Using Eculizumab: A Case Review

## TL;DR

A 36-year-old pregnant woman with atypical hemolytic-uremic syndrome (aHUS) was successfully treated with eculizumab after complications from placental abruption.

## Contribution

This case highlights the successful use of eculizumab in managing aHUS during pregnancy, offering insights into treatment strategies for this rare condition.

## Key findings

- The patient showed marked clinical improvement after eculizumab treatment following a cesarean section.
- Initial plasmapheresis was suboptimal, but eculizumab led to sustained remission without disease relapse.

## Abstract

Hemolytic-uremic syndrome (HUS) is a rare thrombotic microangiopathy characterized by the triad of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury. The disease is pathologically marked by fibrinoid necrosis within renal arterioles and glomerular capillaries. HUS can be categorized into typical variants, often linked to Shiga toxin-producing Escherichia coli (STEC) infection, and atypical variants that stem from dysregulation in the alternative complement pathway. Pregnancy is a recognized predisposing condition for HUS due to the potential reduction in complement regulatory proteins and the possibility of heightened maternal immune response. This report illustrates the case of a 36-year-old woman who, at 36 weeks of gestation, faced a breech presentation and was diagnosed with atypical HUS (aHUS) after placental abruption. Following a cesarean section, she developed complications, including a pelvic hematoma and bilateral hydronephrosis. Despite initial suboptimal response to plasmapheresis, the patient exhibited marked clinical improvement with eculizumab treatment, with no evidence of disease relapse.