Rationale:Atypical hemolytic uremic syndrome (aHUS) is a severe rare disease characterized by microvascular hemolytic anemia, thrombocytopenia, and acute renal failure.Patient concerns:A 10-year-old male presented with symptoms of weakness, jaundice, pallor, swollen eyelids, and no significant lower limb swelling. Laboratory investigations revealed critical hemoglobin levels, fragmented red blood cells, thrombocytopenia, and acute kidney injury.Diagnoses:The patient was diagnosed with aHUS based on the clinical trial of microvascular hemolytic anemia, thrombocytopenia, and organ damage due to thrombosis, as well as laboratory findings.Interventions:The patient was treated with a combination of plasma exchange and the drug Eculizumab. Comprehensive nursing care was provided, including the establishment and maintenance of blood purification pipelines, management of complications (such as coagulation, allergic reactions, hypotension, and bleeding), and psychological support for the patient and family.Outcomes:The patient successfully completed a 3-month treatment regimen with Eculizumab and has been followed up for an additional 10 months without any recurrence of the condition, demonstrating favorable treatment outcomes.Lessons:The novel approach of combining plasma exchange with Eculizumab in pediatric aHUS presents significant nursing challenges, but the case demonstrates the potential benefits of this combination therapy, particularly in the pediatric population in China where Eculizumab has recently become available. Comprehensive nursing care, including managing complications and providing psychological support, is crucial to the successful treatment of aHUS.