Adenomyosis as a Predisposing Factor for Pregnancy-Associated Hemolytic Uremic Syndrome: A Case-Based Mechanistic Study with Literature and Pathophysiological Correlation

Abstract

Background: Hemolytic uremic syndrome (HUS) is a rare obstetric complication with significant renal morbidity. Recent evidence suggests that uterine pathologies like adenomyosis may predispose to thrombotic microangiopathy (TMA), but mechanistic links remain unclear.

Methods: We describe a case of post-abortion pregnancy-associated HUS (pHUS) in a patient with adenomyosis and analyze clinical, histological, and immunological data in the context of TMA mechanisms. We also review existing literature and propose a plausible biological model.

Results: The patient presented with thrombocytopenia, hemolytic anemia, and acute kidney injury, consistent with pHUS. Renal biopsy confirmed TMA. Plasma exchange and eculizumab led to full recovery. A hypothesized model suggests endometrial necrosis, cytokine storm, and complement activation in adenomyosis may trigger pHUS.

Conclusion: This is the first reported case of post-abortion HUS in a patient with adenomyosis. The interplay between decidual necrosis, high secretory endometrial collapse, and microvascular thrombosis may mimic tumor lysis syndrome, triggering TMA. Early recognition and prompt treatment are crucial for a favorable outcome.