Which TMP occurs in children, lacks neurological symptoms, and is associated with infection by enterohemorrhagic E. coli?

• A. Hemolytic-uremic syndrome
• B. Thrombotic thrombocytopenia purpura
• C. Disseminated intravascular coagulation
• D. Idiopathic thrombocytopenia purpura

Answer: (A)

This item hinges on recognizing a thrombotic microangiopathy in children tied to Shiga toxin–producing E. coli. Hemolytic-uremic syndrome presents after a diarrheal illness with microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Neurological symptoms are not typical in the classic pediatric HUS, which helps distinguish it from thrombotic thrombocytopenic purpura, where neuro involvement is more common and ADAMTS13 deficiency often plays a role. Other options don’t fit because disseminated intravascular coagulation shows systemic consumption of coagulation factors with abnormal coagulation tests and bleeding, while idiopathic thrombocytopenia purpura is primarily isolated thrombocytopenia without MAHA or renal injury. Therefore, the description points to hemolytic-uremic syndrome.