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Thrombotic microangiopathies: case report A 64-year-old woman developed thrombotic microangiopathies during treatment with gemcitabine and oxaliplatin for metastatic gallbladder carcinoma [routes and dosages not stated]. The woman presented to the emergency department with asthenia and severe abdominal pain since 5 days. She had an episode of dark stools. Her medical history included hypertension, type 2 diabetes mellitus and metastatic gallbladder carcinoma (T4N1M1) stage IV with metastatic liver disease. Initially, she had received chemotherapy with cisplatin and gemcitabine. But, diseases progression was noted and chemotherapy with capecitabine and oxaliplatin was commenced. Her latest dose of chemotherapy with capecitabine and oxaliplatin was 20 days ago. At current presentation, she was found pale and jaundiced upon physical examination. Her examination of the abdomen showed a palpable stone mass of 10cm diameter located in the right-sided hypochondrium extended towards epigastrium. Her lab results revealed metabolic acidaemia along with severe hyperlactatemia and blood test showed leukocytes 41600 cell/mm3 with neutrophilia, severe thrombocytopenia and macrocytic anaemia. Her kidney function was found to be preserved and abdominal sepsis was suspected. Hence, antibacterial therapy was initiated in the ICU. Subsequent CT scan of abdomen showed a solid hypodense mass in the liver segment VI of 100 × 86mm in close contact and loss of cleavage plane with the gallbladder. Despite antibiotic therapy, her condition worsened and continuous transfusion support was required due to persistent anaemia and thrombocytopenia. Her peripheral blood smear showed positive result for schistocytes and laboratory tests showed lactate dehydrogenase level 978 U/L, indirect bilirubin 1.5 mg/dL, haptoglobin level was less than 8 mg/dL and increased reticulocyte, suggestive of haemolytic anaemia. She developed neurological disorders secondary to mutism and disorientation. Her further laboratory testing showed coagulation abnormalities along with consumed fibrinogen and she was diagnosed with oxaliplatin-induced thrombotic microangiopathies as per the International Working Group criteria. However, she died 17 days after the hospitalisation [immediate cause of death not stated]. It was concluded that the thrombotic microangiopathies was related to gemcitabine and subsequent oxaliplatin therapy, suggestive of the possible multiple-hits model [duration of treatment to reaction onset and outcome not stated]. Fuentes-Lacouture MC, et al. Oxaliplatin-Induced Thrombotic Microangiopathy in a Patient with Stage IV Gallbladder Carcinoma: Primary Association or Multiple Hits?. 803514627 Case Reports in Oncology 13: 1191-1195, 2020. Available from: URL: http://doi.org/10.1159/000510307

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Reactions 14 Nov 2020 No. 1830