A three-year-old male presents with mom for seven days of fever, diarrhea, and decreased activity. When you walk into the room, you note a listless-appearing boy with pallor. His eyes appear sunken. He is tachycardic, tachypneic, and febrile, but with normal blood pressure and saturations for age. He was born at term with no prior medical history, and his immunizations are up to date. Patients presenting in the later stages of HUS may have anemia, thrombocytopenia, and AKI in addition to the diarrhea prodrome. The major conditions in the differential at this stage include diffuse intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), systemic vasculitis, and sepsis.

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