Lectin Polyagglutination in a 2-Year-Old Girl With Acute Presentation of Streptococcus Pneumoniae Pneumonia, Respiratory Syncytial Virus Type B, and Hemolytic Uremic Syndrome

Abstract

A previously healthy 2-year-old unvaccinated girl was admitted for sepsis and bilateral parapneumonic effusions. She was anemic (few tear drops, marked anisocytosis), thrombocytopenic, and in acute renal failure, consistent with hemolytic uremic syndrome (HUS). Her coagulation profile was not consistent with disseminated intravascular coagulation. Blood cultures grew Streptococcus pneumoniae (SP), and nasal washings were twice positive for respiratory syncytial virus (RSV) type B. The clinical team was suspicious for acquired polyagglutination and requested a lectin panel; she had received unwashed RBCs and platelets at the transferring institution. Lectin panels were performed by Bonfils Blood Center Reference Laboratory (Denver, CO). The first lectin panel was positive against the following lectins: Arachis hypogea, Glycine soja, Salvia horminum, Salvia sclarea. Blood type was O+; antibody screen was negative. No direct antiglobulin test was performed. The second lectin panel, performed after several days of antibiotic treatment, was entirely negative. The initial lectin panel demonstrated polyagglutination, an unusual pattern with her acute clinical presentation. Literature describes a single case of Tr polyagglutination, suggested to be inherited. Although it is possible that inherited and microbially induced polyagglutination patterns were concurrent, perhaps polyagglutination may also be induced by microbial disease processes (mutations or inherited processes were not disproven in this case). Organisms such as S pneumoniae (associated with HUS) produce neuraminidases that cleave RBC, platelet, and glomerular capillary endothelial cell sialic residues, exposing cryptantigens and leading to an entity known as T activation. T antibody is ubiquitous in normal plasma and may threaten those tissues when transfused. When T activation is detected, washed cellular products should be provided until the lectin panel no longer is positive.