Adalimumab as a potential cause of drug-induced thrombocytopaenic microangiopathy

BMJ Case Reports
Lorenzo FalsettiCinzia Nitti

Abstract

We report the case of a 63-year-old male patient admitted to our emergency department for dyspnoea, peripheral oedema, severe diarrhoea and asthenia. History revealed Crohn's disease (CD) submitted to several intestinal surgical resections in the previous years. He recently started a treatment with adalimumab for the control of CD. Laboratory tests at the admission revealed severe haemolytic anaemia and thrombocytopaenia. Haptoglobin levels were low, schistocyte count was markedly increased. In the suspect of thrombotic microangiopathy, he was admitted to our internal medicine department where we urgently started plasma exchange (PEX). We observed normal ADAMTS-13 activity in absence of Shiga toxin or enterotoxic Escherichiacoli at stool tests. Despite a diagnosis of atypical haemolytic-uraemic syndrome, we observed full platelet count recovery and schistocytes normalisation after the fourth PEX. We then put a diagnosis of adalimumab-induced thrombocytopaenic microangiopathy. Adalimumab was withdrawn. We did not observe relapses in the following 3 months.

References

Dec 19, 2002·Journal of Clinical Gastroenterology·Nicolas SchleinitzSophie Jego-Desplat
Jun 23, 2004·Gastroenterología y hepatología·N Manceñido MarcosJ M Segura Cabral
Jul 17, 2004·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Jeffrey S DlottLeo J McCarthy
Jan 9, 2007·Alimentary Pharmacology & Therapeutics·S Kulnigg, C Gasche
Apr 27, 2012·Journal of Crohn's & Colitis·M J CasanovaJ P Gisbert
Oct 19, 2016·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Donald M ArnoldIshac Nazy
Oct 29, 2017·Hematology/oncology Clinics of North America·Shane KapplerAutumn Graham

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