The Use of Eculizumab in Tacrolimus-Induced Thrombotic Microangiopathy

Abstract

Drug-induced thrombotic microangiopathy (DITMA) is a secondary cause of thrombotic microangiopathy and a potentially fatal inflammatory disease. DITMA has been attributed to a variety of drugs, particularly chemotherapeutic and immunosuppressive agents. Prompt diagnosis is critical for survival and treatment necessitates withdrawal of the offending drug; however, many cases require further treatment including plasmapheresis, immunosuppression, and anticoagulation. In this article, we report a cutaneous biopsy-proven case of tacrolimus-induced DITMA, which was successfully treated with eculizumab after failing the conventional standard of care.

Keywords: DITMA; drug-induced thrombotic microangiopathy; eculizumab; tacrolimus.

Figure 1.

Shows patients lower extremity images before and after eculizumab therapy. Images A to H show the patient’s right and left lower extremity prior to eculizumab therapy. Images I to L show the patients right and left lower extremity 48 hours after eculizumab therapy.

Figure 2.

Hematoxylin-eosin (H&E) sections from skin over the left foot shows extensive dermal hemorrhage (A and B) and rare fibrin thrombi in small vessels. H&E sections of skin and subcutaneous tissue from the right leg (C and D) show numerous fibrin thrombi within small vessels.