Q: 17 year old male is admitted with bloody diarrhea and vomiting. Patient visited petting zoo 3 days ago with his friend. Now patient is hypotensive, no urine out put and altered mental status. Probable diagnosis?

Answer: HUS

Hemolytic Uremic syndrome (HUS) should be high on list with bloody diarrhea after visit to petting zoo. Other risk factors include contamination via hamburger or contact to infected person.

• The GI symptoms usually starts after 4-6 days. Diarrhea typically become hemorrhagic and may quickly set into septic shock.

Antibiotics are usually not required, actually discouraged. Minor cases can be treated with supportive treatment but in cases like above plasma exchange (plasmapheresis combined with fresh-frozen plasma replacement) is currently the treatment of choice.