Drug-induced thrombotic thrombocytopenic purpura successfully treated with recombinant human soluble thrombomodulin

Intern Med. 2013;52(10):1111-4. doi: 10.2169/internalmedicine.52.9180. Epub 2013 May 15.

Abstract

A 61-year-old woman with recurrent non-small cell lung cancer presented with thrombocytopenia, microangiopathic hemolytic anemia, neurological abnormalities, renal failure and a fever that appeared during chemotherapy with gemcitabine and bevacizumab. She was diagnosed with drug-induced thrombotic thrombocytopenic purpura (TTP). After the discontinuation of chemotherapy, the administration of recombinant human soluble thrombomodulin and fresh-frozen plasma rapidly ameliorated the TTP. Hypertension preceded the onset of TTP and required the administration of quadruple therapy on admission. However, after three months, the hypertension was controllable without anti-hypertensive drugs. Twelve months later, the ninth course of vinorelbine was administered safely, preventing the patient's lung cancer from progressing.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / etiology
  • Antibodies, Monoclonal, Humanized / administration & dosage
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antihypertensive Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bevacizumab
  • Carcinoma, Large Cell / complications
  • Carcinoma, Large Cell / drug therapy
  • Carcinoma, Non-Small-Cell Lung / complications
  • Carcinoma, Non-Small-Cell Lung / drug therapy
  • Cisplatin / administration & dosage
  • Combined Modality Therapy
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / adverse effects
  • Deoxycytidine / analogs & derivatives
  • Docetaxel
  • Erlotinib Hydrochloride
  • Female
  • Glutamates / administration & dosage
  • Guanine / administration & dosage
  • Guanine / analogs & derivatives
  • Humans
  • Hypertension / drug therapy
  • Hypertension / etiology
  • Lung Neoplasms / complications
  • Lung Neoplasms / drug therapy
  • Middle Aged
  • Oxonic Acid / administration & dosage
  • Pemetrexed
  • Plasma
  • Purpura, Thrombotic Thrombocytopenic / chemically induced
  • Purpura, Thrombotic Thrombocytopenic / drug therapy*
  • Purpura, Thrombotic Thrombocytopenic / therapy
  • Pyridines / administration & dosage
  • Quinazolines / administration & dosage
  • Recombinant Proteins / therapeutic use
  • Solubility
  • Taxoids / administration & dosage
  • Tegafur / administration & dosage
  • Thrombomodulin / therapeutic use*

Substances

  • Antibodies, Monoclonal, Humanized
  • Antihypertensive Agents
  • Glutamates
  • Pyridines
  • Quinazolines
  • Recombinant Proteins
  • THBD protein, human
  • Taxoids
  • Thrombomodulin
  • Pemetrexed
  • Deoxycytidine
  • Tegafur
  • Docetaxel
  • Bevacizumab
  • Oxonic Acid
  • Guanine
  • gemcitabine
  • Erlotinib Hydrochloride
  • Cisplatin
  • gimeracil