Elevated reticulocyte count - a clue to the diagnosis of haemolytic-uraemic syndrome (HUS) associated with gemcitabine therapy for metastatic duodenal papillary carcinoma: a case report

• Published in: British journal of cancer 1999-03, Vol.79 (9-10), p.1519-1521
• Main Authors: Serke, S, Riess, H, Oettle, H, Huhn, D
• Format: Article
• Language: English
• Subjects: Adult; Anemia - chemically induced; Antimetabolites, Antineoplastic - adverse effects; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cancer Research; Carcinoma, Papillary - drug therapy; Carcinoma, Papillary - secondary; Deoxycytidine - adverse effects; Deoxycytidine - analogs & derivatives; Drug Resistance; Drug toxicity and drugs side effects treatment; Duodenal Neoplasms - drug therapy; Duodenal Neoplasms - secondary; Epidemiology; Hemolytic-Uremic Syndrome - blood; Hemolytic-Uremic Syndrome - chemically induced; Hemolytic-Uremic Syndrome - diagnosis; Humans; Male; Medical sciences; Molecular Medicine; Oncology; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pharmacology. Drug treatments; Regular; regular-article; Reticulocyte Count; Thrombocytopenia - chemically induced; Toxicity: blood
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/sj.bjc.6690242

Summary In adults, the haemolytic-uraemic syndrome (HUS) is associated with probable causative factors in the minority of all cases. Cytotoxic drugs are one of these potential causative agents. Although metastatic cancer by itself is a recognized risk-factor for the development of HUS, therapy with mitomycin-C, with cis -platinum, and with bleomycin carries a significant, albeit extremely small, risk for the development of HUS, compared with all other cytotoxic drugs. Gemcitabine is a novel cytotoxic drug with promising activity against pancreatic adenocarcinoma. We are reporting on one patient with metastatic duodenal papillary carcinoma developing HUS while on weekly gemcitabine therapy. The presenting features in this patient were non-cardiac pulmonary oedema, renal failure, thrombocytopenia and haemolytic anaemia. The diagnosis of HUS was made on the day of admission of the patient to this institution. Upon aggressive therapy, including one single haemodialysis and five plasmaphereses, the patient recovered uneventfully, with modestly elevated creatinine-values as a remnant of the acute illness. Re-exposure to gemcitabine 6 months after the episode of HUS instituted for progressive carcinoma, thus far has not caused another episode of HUS.