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Volume 39, Number 4, August 2006

Pneumococcal pneumonia with empyema and hemolytic uremic syndrome in children: report of three cases

Chih-Fang Lee, Shu-Chih Liu, Ko-Huang Lue, Jung-Pin Chen, Ji-Nan Sheu
Divisions of Pediatric Immunology and Pediatric Infectious Diseases, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung; Institute of Medicine, Chung Shan Medical University, Taichung; and Divisions of Pediatric Nephrology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan

Received: December 27, 2005    Revised: February 3, 2006    Accepted: February 11, 2006   


Corresponding author:

Dr. Ji-Nan Sheu, Department of Pediatrics, Chung Shan Medical University Hospital , No.110, Section 1, Chien-Kuo North Road , Taichung 402, Taiwan . E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it




Streptococcus pneumoniae is an uncommon etiological organism in children with hemolytic uremic syndrome (HUS). Patients with S. pneumoniae - associated HUS commonly have a pneumonia or meningitis. Historically, S. pneumoniae -associated HUS usually has a poor clinical outcome. We report 3 pediatric cases of pneumococcal pneumonia-induced HUS. All 3 patients were < 2 years old, had an empyema complicating pneumococcal pneumonia, and developed renal failure with oliguria and required peritoneal dialysis for a period of 9 to 26 days. All children received several transfusions of unwashed packed red cells and platelets. All of the patients survived. Of the 3 cases, 2 had a normal renal function at discharge, and 1 had a mild renal impairment at 16-month follow-up. Our report suggests S. pneumoniae - associated HUS remains a rare but severe complication of invasive pneumococcal infection in children. It is important for pediatricians to note that children with pneumococcal pneumonia with severe hematologic and renal dysfunction should be investigated for evidence of S. pneumoniae-associated HUS.



Key words:

Empyema, hemolytic-uremic syndrome, pneumonia, renal function tests, Streptococcus pneumoniae



J Microbiol Immunol Infect 2006;39:348-352.