Acute and fatal thrombocytopenic thrombotic purpura after a single dose of pemetrexed

Int J Clin Pharm. 2014 Dec;36(6):1141-3. doi: 10.1007/s11096-014-0032-9. Epub 2014 Nov 5.


Case: Thrombocytopenic thrombotic purpura (TTP), a life-threatening event consisting of disseminated vascular thrombosis, has never been described before as a possible side effect of the anticancer drug pemetrexed. A 70 years old patient affected by a poorly differentiated non small cell lung cancer, subjected to his first pemetrexed administration, developed an acute thrombocytopenic thrombotic purpura, fatal in a few hours.

Conclusions: Pemetrexed can cause TTP. Clinicians have to be alert for the rapid onset and aggressiveness of this possible side effect. It is difficult to recognise the first signs and symptoms.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Aged
  • Antimetabolites, Antineoplastic / administration & dosage*
  • Antimetabolites, Antineoplastic / adverse effects*
  • Fatal Outcome
  • Glutamates / administration & dosage*
  • Glutamates / adverse effects*
  • Guanine / administration & dosage
  • Guanine / adverse effects
  • Guanine / analogs & derivatives*
  • Humans
  • Male
  • Pemetrexed
  • Purpura, Thrombotic Thrombocytopenic / chemically induced*
  • Purpura, Thrombotic Thrombocytopenic / diagnosis*


  • Antimetabolites, Antineoplastic
  • Glutamates
  • Pemetrexed
  • Guanine