BMJ Case Reports 2014; doi:10.1136/bcr-2013-203122

Opana ER abuse and thrombotic thrombocytopenic purpura (TTP)-like illness: a rising risk factor in illicit drug users

  1. Jeffery Summers1
  1. 1Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
  2. 2Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut, USA
  3. 3Saint Vincent Hospital, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  1. Correspondence to Dr Lovely Chhabra, lovids{at}
  • Accepted 3 February 2014
  • Published 3 March 2014


We report the case of a 22 year-old-woman who presented with upper extremity cellulitis secondary to an infiltration of illicit intravenous drug use. She confessed to the intravenous use of Opana ER (an extended release oral formulation of oxymorphone) which is an opioid drug approved only for oral use. She was found to have clinical evidence of profound thrombotic microangiopathy which resulted due to the intravenous use of Opana ER. She showed full clinical improvement after withholding drug and supportive clinical care. Recent report of Opana ER intravenous abuse was published from Tennessee county and has now been increasingly recognised as one of the causes of thrombocytopenia which mimicks clinically as thrombotic thrombocytopenic purpura. Physicians should be aware of this association as the lack of familiarity to this can pose serious management dilemmas for our patients (especially the polysubstance abusers).

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