Objetive Hemolytic uremic syndrome (HUS) is a severe complication of invasive pneumoccal infection and is considered to lead to higher mortality and long-term morbidity than the typical form. We report two cases in previously healthy children.

Methods Case series.

Results 1: An eleven-month-old boy with an otitis media was admitted to our hospital because of progressive decay and a left III cranial nerve paresis. Cranial computed tomography was normal. Cerebrospinal fluid showed data consistent with bacterial meningitis and blood culture was positive for S pneumoniae serotype 19F. He developed oliguric acute renal failure, microangiopathic haemolytic anemia (7’2 g/dl) and thrombocytopenia (24000/mm³) and he needed peritoneal dialysis. He underwent acute respiratory distress syndrome and needed mechanical ventilation, with refractory hypoxemia and coma. He finally died. 2: A three-year-old girl with pneumonia and empyema was referred to our hospital for suspected HUS (anemia 6’3 g/dl, schistocytosis, thrombocytopenia 43000/mm³, creatinine 2’21 mg/dl). She had received complete heptavalent pneumococcal conjugate vaccination. She required mechanical ventilation and video-assisted thoracoscopy surgery was performed. S pneumoniae was isolated from pleural fluid; it was resistant to penicillin and macrolides, with intermediate susceptibility to ceftriaxone/cefotaxime and vancomycine, so she was treated with levofloxacin plus ceftriaxone. We started continuous venovenous hemodiafiltration until a permanent peritoneal catheter was placed. She recovered normal renal function after 12 days.

Conclusions HUS is a serious complication associated with S. pneumoniae, which involves establishing an appropriate antibiotic treatment together with supportive measures. In our country, it’s unusual the multiple pneumococcal resistance to antibiotics.