Complement C5 inhibition reverses bleomycin-induced thrombotic microangiopathy

Sofiane Salhi; David Ribes; Stanislas Faguer

doi:10.1093/ckj/sfaa101

Complement C5 inhibition reverses bleomycin-induced thrombotic microangiopathy

Clin Kidney J. 2020 Jul 9;14(4):1275-1276. doi: 10.1093/ckj/sfaa101. eCollection 2021 Apr.

Authors

Sofiane Salhi¹, David Ribes¹, Stanislas Faguer^{1

2

3}

Affiliations

¹ Department of Nephrology and Organ Transplantation, Centre for Rare Renal Diseases, University Hospital of Toulouse, Toulouse, France.
² Institut National de la Santé et de la Recherche Médicale, U1048-Institut des Maladies Métaboliques et Cardiovasculaires, French Intensive care Renal Network, Toulouse, France.
³ Université Paul Sabatier, Toulouse 3, Toulouse, France.

Abstract

Whether C5 blocking may improve the outcomes of patients developing chemotherapy-induced thrombotic microangiopathy (TMA) remains elusive. Lung fibrosis is a well-known complication of bleomycin, whereas TMAs are very rare (<20 cases described). Here, we report an exceptional case of a male patient that developed acute respiratory distress syndrome and TMA following administration of bleomycin, cisplatin and etoposide . Refractoriness to plasma exchanges prompted us to use eculizumab as salvage therapy. Eculizumab led to complete remission of the TMA before Day 2. However, the patient progressed towards refractory respiratory failure, suggesting that pathophysiological mechanisms of bleomycin-induced lung fibrosis and TMA differ.

Keywords: bleomycin; complement; eculizumab; lung fibrosis; thrombotic microangiopathy.

Publication types

Case Reports