BMJ Case Reports 2017; doi:10.1136/bcr-2017-220977
  • Unexpected outcome (positive or negative) including adverse drug reactions

Thrombotic microangiopathy associated with intravenous injection of extended-release oxycodone

  1. Harshal Nandurkar4
  1. 1Department of Nephrology, Western Health, Melbourne, Australia
  2. 2Clinical Haematology, Royal Melbourne Hospital, Melbourne, Australia
  3. 3Department of Haematology, St Vincent's Health, Melbourne, Australia
  4. 4Clinical Haematology & Australian Centre for Blood Diseases, Alfred Health, Melbourne, Australia
  1. Correspondence to Dr Kate J Robson, katejrobson{at}
  • Accepted 23 June 2017
  • Published 17 July 2017


We describe the case of a 35-year-old man presenting with thrombotic microangiopathy (TMA) and renal impairment following, as he later disclosed, intravenous injection of oral formulation tamper-resistant extended-release oxycodone hydrochloride (Oxycontin). Recurrent misuse of this agent was associated with relapsing TMA despite treatment with terminal complement inhibitor eculizumab. Cases of TMA have been reported in the USA in association with intravenous misuse of extended-release oxymorphone (Opana ER) after the introduction of a new non-crushable formulation in 2012. There are two reported accounts of TMA associated with tamper-resistant Oxycontin, which became available in Australia in 2014. This is the first documented case in which eculizumab was used. This case illustrates the practical diagnostic challenges in identifying TMA disorders, and the importance of a detailed drug history. It also highlights the need to clarify what role, if any, eculizumab therapy has in cases of drug-associated TMA.


  • Contributors KJR, DC, RF and HN conceptualised the report and literature review, all having been involved in the patient's care. KJR and DC prepared the manuscript.RF and HN reviewed and drafted the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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