TY - JOUR
T1 - Thrombotic microangiopathy associated with intravenous injection of extended-release oxycodone
AU - Robson, Kate J.
AU - Clucas, Danielle
AU - Filshie, Robin J A
AU - Nandurkar, Harshal
PY - 2017
Y1 - 2017
N2 - We describe the case of a 35-year-old man presenting with thrombotic microangiopathy (TMA) and renal impairment following, as he later disclosed, intravenous injection of oral formulation tamper-resistant extended-release oxycodone hydrochloride (Oxycontin). Recurrent misuse of this agent was associated with relapsing TMA despite treatment with terminal complement inhibitor eculizumab. Cases of TMA have been reported in the USA in association with intravenous misuse of extended-release oxymorphone (Opana ER) after the introduction of a new non-crushable formulation in 2012. There are two reported accounts of TMA associated with tamper-resistant Oxycontin, which became available in Australia in 2014. This is the first documented case in which eculizumab was used. This case illustrates the practical diagnostic challenges in identifying TMA disorders, and the importance of a detailed drug history. It also highlights the need to clarify what role, if any, eculizumab therapy has in cases of drug-Associated TMA.
AB - We describe the case of a 35-year-old man presenting with thrombotic microangiopathy (TMA) and renal impairment following, as he later disclosed, intravenous injection of oral formulation tamper-resistant extended-release oxycodone hydrochloride (Oxycontin). Recurrent misuse of this agent was associated with relapsing TMA despite treatment with terminal complement inhibitor eculizumab. Cases of TMA have been reported in the USA in association with intravenous misuse of extended-release oxymorphone (Opana ER) after the introduction of a new non-crushable formulation in 2012. There are two reported accounts of TMA associated with tamper-resistant Oxycontin, which became available in Australia in 2014. This is the first documented case in which eculizumab was used. This case illustrates the practical diagnostic challenges in identifying TMA disorders, and the importance of a detailed drug history. It also highlights the need to clarify what role, if any, eculizumab therapy has in cases of drug-Associated TMA.
KW - acute renal failure
KW - drug misuse (including addiction)
KW - haematology (drugs and medicines)
KW - haematology (incl blood transfusion)
KW - unwanted effects / adverse reactions
UR - http://www.scopus.com/inward/record.url?scp=85024891604&partnerID=8YFLogxK
U2 - 10.1136/bcr-2017-220977
DO - 10.1136/bcr-2017-220977
M3 - Article
C2 - 28716778
AN - SCOPUS:85024891604
SN - 1757-790X
VL - 2017
JO - BMJ Case Reports
JF - BMJ Case Reports
M1 - 220977
ER -