Kidney Week

Abstract: SA-PO827

Penicillin-Induced Thrombotic Microangiopathy

Session Information

• C3G, TMA, MGRS, Amyloidosis, and More
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Author

• Lai, Huanchun N., McLaren Health Care Corp, Mt Clemens, Michigan, United States

Huanchun N. Lai, MD

Introduction

Thrombotic microangiopathies (TMA) are characterized by features of thrombocytopenia, microangiopathic hemolytic anemia, acute kidney injury, combined with cardiac and neurologic abnormalities. Drug-induced thrombotic microangiopathy (DITMA) is an acquired condition due to either immune (antibody-mediated) or non-immune (direct toxicity) mediated organ dysfunction secondary to medication exposure. DITMA is an uncommon condition that can be fatal if the diagnosis is missed. It must be considered in the presence of characteristic features, without evidence of systemic causes of TMA. Here, we describe a case of penicillin-induced TMA in a previously healthy individual.

Case Description

A 25-year-old male with no medical history presented with three-day history of hematuria and non-bloody diarrhea. Patient was treated one week prior for a dental infection with penicillin VK for four days. On admission, patient had no other complaints other than persistent hematuria. Initial lab work showed significant thrombocytopenia of 23K/mcL, PBS 2+ schistocytes, haptoglobin <10mg/dL, LDH 2,600U/L, creatinine of 2.1mg/dL, and UA had RBC count of 27. Serologic workup showed normal C3 and C4, ANA, dsDNA, GBM, MPO and PR3 were all negative. DAT, SPEP, and HIV were negative. ADAMTS13 activity was normal. Patient was started on prednisone with improvement of platelets and renal function, without the need for plasma exchange. Patient completed a six week prednisone taper with resolution of symptoms and renal recovery.

Discussion

DITMA is uncommon but poses potential life-threatening complications. It is under-recognized due to diagnostic challenges and lack of standardized testing. Therefore, it is difficult to establish a causal relationship with the implicated agent. Most commonly, DITMA is associated with quinine and chemotherapy agents. There are rare reports of penicillin as cause of DITMA in literature. This case further highlights penicillin as a cause of TMA and illustrates the management and anticipated recovery after the cessation of the offending medication.

Days since initial exposure to Penicillin VK and the progression of DITMA