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Medical Science Monitor Basic Research


A Case of Evans Syndrome with Acute Hemolysis and Hemoglobin Cast Nephropathy

Challenging differential diagnosis, Rare disease

Felicia Sadie Couri, Manasa Kandula

USA Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA

Am J Case Rep 2020; 21:e920760

DOI: 10.12659/AJCR.920760

Available online: 2020-01-24

Published: 2020-02-07


BACKGROUND: Evans syndrome is characterized by ‘warm’ autoimmune hemolytic anemia and autoimmune thrombocytopenia, and is more common in the pediatric population than in adults. Evans syndrome is often associated with underlying autoimmune disease, connective tissue disease, immune deficiency disorders, lymphoproliferative disorders, or malignancy of the immune system. A case is presented of acute kidney injury due to hemoglobin cast nephropathy in an adult man with Evans syndrome.
CASE REPORT: A 60-year-old man was diagnosed with Evans syndrome, which was complicated by acute renal failure that required treatment with hemodialysis. Laboratory tests and renal histology confirmed a diagnosis of hemolysis-associated hemoglobin cast nephropathy.
CONCLUSIONS: The diagnosis of Evans syndrome is important as it may be associated with underlying hematological and immunological disorders. Although rare, hemoglobin cast nephropathy due to hemolysis can be a cause of acute kidney injury in patients with Evans syndrome.

Keywords: acute kidney injury, Anemia, Hemolytic, Anemia, Hemolytic, Autoimmune, Purpura, Thrombocytopenic, Idiopathic, Thrombocytopenia