Thrombotic Microangiopathy Associated with
Gemcitabine: A Case Report
Piyakarn Watcharenwong MD1, Jarin Chindaprasirt MD1, Aumkhae Sookprasert MD1,
Kosin Wirasorn MD1, Kittrawee Kritmetapak MD2, Anucha Puapiroj MD3
Affiliation :
1 Division of Medical Oncology, Srinagarind Hospital Medical School, Faculty of Medicine, Khon Kaen University,
Khon Kaen, Thailand
2 Division of Nephrology, Srinagarind Hospital Medical School, Faculty of Medicine, Khon Kaen University,
Khon Kaen, Thailand
3 Department of Pathology, Srinagarind Hospital Medical School, Faculty of Medicine, Khon Kaen University,
Khon Kaen, Thailand
Many etiologies have resulted in thrombotic microangiopathy [TMA], amongst which are antineoplastic
chemotherapies. Gemcitabine-related thrombotic microangiopathy [TMA] has rarely been described, but it is a life-threatening
complication. However, only a few case reports have been conducted in Thailand. A 52-year-old male who was diagnosed
with cholangiocarcinoma and was treated with surgery and gemcitabine. After that, he developed acute kidney injury,
generalized edema, and hemolytic anemia. The kidney biopsy revealed three renal pathologies in this patient that included
lupus nephritis class V, chronic thrombotic microangiopathy, and drug-induced acute interstitial nephritis. A review of the
medical record of the patient plus a comparison with the literature was conducted. The patient was treated with permanently
stop gemcitabine, prednisolone, anti-hypertensive drugs and blood transfusion. His renal function and hemolytic anemia
improved in one month later.
Keywords : Thrombotic microangiopathy, TMA, Gemcitabine
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