Hemolyitic uremic syndrome (HUS), characterized by triad of acute kidney injury, 
thrombocytopenia, and hemolytic anemia, has considerable morbidity and mortality 
and is known to be associated with diarrheal illness. It usually occurs after a 
diarrheal illness due to Shiga-toxin-producing Escherichia coli. Streptococcus 
pneumoniae is a rare but well recognized trigger for non-diarrhea associated HUS 
in children, but has not been reported in adults. We report a case of an adult 
presenting with pneumococcal pneumonia complicated by HUS and required renal 
replacement therapy.