BACKGROUND: Hemolytic uremic syndrome, one of the common causes of acute renal 
failure in children, is characterized by the triad of microangiopathy, 
haemolytic anemia, thrombocytopenia and acute renal failure. The 
diarrhoea-associated Hemolytic uremic syndrome is usually termed as a typical 
Hemolytic uremic syndrome. Streptococcus pneumoniae is an uncommon etiological 
pathogen for inducing Hemolytic uremic syndrome, and Streptococcus pneumoniae 
associated Hemolytic uremic syndrome is also termed as atypical hemolytic uremic 
syndrome.
AIM: to report two pediatric cases of invasive S pneumoniae complicated with 
hemolytic uremic syndrome HUS.
CASE REPORT: The first patient presented with pneumococcal pneumonia and empyema 
and the second patient presented with pneumococcal pneumonia and meningitis. The 
two patients were under one year of age and required peritoneal dialysis with 
improvement of renal function in one; the other died.
CONCLUSION: Pneumococcal invasive disease may be a cause of severe HUS, so a 
high index of suspicion is mandatory to prompt appropriate diagnosis and 
management.