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Rare disease
CASE REPORT
Metastatic lung adenocarcinoma- associated thrombotic microangiopathy in a renal transplant recipient
  1. Eswari Vilayur1,2,
  2. Jillian de Malmanche3,
  3. Paul Trevillian1,2 and
  4. David Ferreira4,5
  1. 1 School of Epidemiology and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
  2. 2 Newcastle Transplant Unit, John Hunter Hospital, Newcastle, New South Wales, Australia
  3. 3 Haematology Department, Calvary Mater Hospital, Newcastle, New South Wales, Australia
  4. 4 Medical Department, Liverpool Hospital, Sydney, New South Wales, Australia
  5. 5 School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Eswari Vilayur, Eswari.Vilayur{at}hnehealth.nsw.gov.au

Abstract

Thrombotic microangiopathy (TMA) after renal transplantation can be a diagnostic challenge. TMA can occur with calcineurin inhibitors, allograft rejection, infection, mutations in complement regulatory proteins and autoimmunity. A 52-year-old male renal transplant recipient presented with extensive deep vein thrombosis. He developed transfusion-dependent microangiopathic haemolytic anaemia with thrombocytopenia. He did not respond calcineurin inhibitor cessation, eculizumab or plasma exchange. ADAMTS13 and complement levels were normal. Infection and autoimmune screens were negative. A diagnosis of metastatic adenocarcinoma was made on bone marrow biopsy. This represents a rare case of malignancy-associated TMA in a renal transplant recipient. Early diagnosis can facilitate the prompt initiation of chemotherapy which is the only treatment option.

  • renal transplantation
  • haematology (incl blood transfusion)
  • acute renal failure
  • respiratory cancer

https://doi.org/10.1136/bcr-2018-226707

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    Footnotes

    • Patient consent for publication Next of kin consent obtained.

    • Contributors EV: responsible for the initial draft of the manuscript, histology slide and consent acquisition. JdM: provided editing and advice from the specialist haematology perspective. PT: provided editing and advice from the specialist renal transplant perspective. DF: revision and editing of the draft document and histological slide.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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