Open AccessMetastatic lung adenocarcinoma- associated thrombotic microangiopathy in a renal transplant recipient
Author(s) -
Eswari Vilayur,
Jillian de Malmanche,
Paul Trevillian,
David Ferreira
Publication year - 2018
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-226707
Subject(s) - thrombotic microangiopathy , medicine , eculizumab , microangiopathic hemolytic anemia , calcineurin , malignancy , plasmapheresis , aplastic anemia , adamts13 , gastroenterology , pathology , transplantation , thrombotic thrombocytopenic purpura , immunology , bone marrow , complement system , platelet , disease , antibody
Thrombotic microangiopathy (TMA) after renal transplantation can be a diagnostic challenge. TMA can occur with calcineurin inhibitors, allograft rejection, infection, mutations in complement regulatory proteins and autoimmunity. A 52-year-old male renal transplant recipient presented with extensive deep vein thrombosis. He developed transfusion-dependent microangiopathic haemolytic anaemia with thrombocytopenia. He did not respond calcineurin inhibitor cessation, eculizumab or plasma exchange. ADAMTS13 and complement levels were normal. Infection and autoimmune screens were negative. A diagnosis of metastatic adenocarcinoma was made on bone marrow biopsy. This represents a rare case of malignancy-associated TMA in a renal transplant recipient. Early diagnosis can facilitate the prompt initiation of chemotherapy which is the only treatment option.