Thrombotic microangiopathy associated with intravenous injection of extended-release oxycodone

Kate J. Robson, Danielle Clucas, Robin J A Filshie, Harshal Nandurkar

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7 Citations (Scopus)


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.

Original languageEnglish
Article number220977
JournalBMJ Case Reports
Publication statusPublished - 2017
Externally publishedYes


  • acute renal failure
  • drug misuse (including addiction)
  • haematology (drugs and medicines)
  • haematology (incl blood transfusion)
  • unwanted effects / adverse reactions

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