STEC-HUS in Pregnancy — ESENeph MCQ

Correct answer: D — Shiga toxin-associated haemolytic uraemic syndrome

The best answer is “Shiga toxin-associated haemolytic uraemic syndrome”. UKHSA describes STEC-HUS as microangiopathic haemolytic anaemia, thrombocytopenia and acute kidney injury following STEC illness. Pregnancy broadens the differential, but the stool result and preserved ADAMTS13 resolve it. “Immune thrombotic thrombocytopenic purpura” is less appropriate because the ADAMTS13 activity is not severely deficient and the diarrhoeal Shiga-toxin evidence identifies another thrombotic microangiopathy “HELLP syndrome” is less appropriate because the defining haemolysis and thrombocytopenia are linked here to Shiga-toxin diarrhoeal illness rather than the obstetric liver-enzyme syndrome “Complement-mediated atypical haemolytic uraemic syndrome” is less appropriate because documented Shiga toxin after bloody diarrhoea provides a specific infectious trigger and classification “Acute fatty liver of pregnancy” is less appropriate because this does not explain the Shiga-toxin-positive diarrhoeal prodrome and microangiopathic triad

Reference: UKHSA guidance: STEC diagnosis and notification: https://www.gov.uk/guidance/shiga-toxin-producing-escherichia-coli-stec-diagnosis-and-notification