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Case Reports
. 2024 Dec 18;16(12):e75947.
doi: 10.7759/cureus.75947. eCollection 2024 Dec.

A Case of Eltrombopag-Induced Thrombotic Microangiopathy Initiating Hemodialysis

Haruka Fukuda  1 , Mineaki Kitamura  2 , Sayaka Sugiyama  1 , Atsushi Sawase  1 , Hiroshi Yamashita  1 , Hideki Tsushima  3 , Junji Irie  4 , Eisuke Katafuchi  5 , Toshiyuki Nakayama  5 , Hiroshi Mukae  6 , Tomoya Nishino  2
Affiliations
Case Reports

A Case of Eltrombopag-Induced Thrombotic Microangiopathy Initiating Hemodialysis

Haruka Fukuda et al. Cureus. .

Abstract

Thrombopoietin receptor agonists are used in addition to steroids for idiopathic thrombocytopenic purpura. A 55-year-old male with idiopathic thrombocytopenic purpura, treated with eltrombopag, developed a rapid decline in renal function following the increase in eltrombopag dose. Renal biopsy showed glomerular endothelial disorder and platelet thrombus, which suggested eltrombopag-induced renal-limited thrombotic microangiopathy. He was treated with steroids; however, his renal function did not improve, and hemodialysis was initiated. During the treatment, acute myocardial infarction and arteriovenous fistula obstruction occurred. After that, he was subsequently diagnosed with antiphospholipid antibody syndrome. Eltrombopag can cause thrombotic microangiopathy and, in some cases, result in renal failure. Patients with idiopathic thrombocytopenic purpura coexisted with antiphospholipid antibody syndrome are at increased risk of thrombosis with thrombopoietin agonists and require careful follow-up.

Keywords: antiphospholipid syndrome; eltrombopag; end-stage renal disease (esrd); idiopathic thrombocytopenic purpura; thrombotic microangiopathy.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Nagasaki Harbor Medical Center Institutional Review Board issued approval not applicable. This article does not contain any studies with animals performed by any of the authors. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Clinical course of this case
Figure 2
Figure 2. Light microscopic finding of periodic acid-methenamine silver staining x200
Diffuse double contour of the glomerular basement membrane and fibrin thrombi are observed in glomerular capillary loops. The arrow indicates the double contour.
Figure 3
Figure 3. Phosphotungstic acid hematoxylin staining (x400)
Arrow heads indicate that there are fibrin thrombi in the capillary loop.
Figure 4
Figure 4. CD-61 staining (x200)
Arrow heads indicate the existence of platelets in the thrombi.
Figure 5
Figure 5. Electron microscopic staining (x1500)
Diffuse foot process loss and subendothelial swelling were observed. Arrows show subendothelial swelling.
See this image and copyright information in PMC

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