Nitrofurantoin-induced microangiopathic haemolytic anaemia and thrombocytopaenia in a patient with systemic lupus erythematosus

• Published in: BMJ case reports 2012-09, Vol.2012, p.bcr-2012-006507
• Main Authors: López-López, Linnette, Rivera-Rodríguez, Noridza, Vilá, Luis M
• Format: Article
• Language: English
• Subjects: Anemia; Anemia, Hemolytic - chemically induced; Anemia, Hemolytic - diagnosis; Anemia, Hemolytic - immunology; Anemia, Hemolytic - therapy; Anti-Infective Agents, Urinary - adverse effects; Anti-Infective Agents, Urinary - therapeutic use; Anti-Inflammatory Agents - administration & dosage; Antibiotics; Antibodies; Apheresis; Blood; Blood platelets; Combined Modality Therapy; Cyclophosphamide - administration & dosage; Dehydrogenases; Female; Fever; Follow-Up Studies; Hematology; Hemoglobin; Humans; Immunosuppressive Agents - administration & dosage; Infusions, Intravenous; Leukocytes; Lupus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - immunology; Methylprednisolone - administration & dosage; Middle Aged; Nitrofurantoin - adverse effects; Nitrofurantoin - therapeutic use; Other; Patients; Plasma; Plasma Exchange; Plasmapheresis; Purpura, Thrombotic Thrombocytopenic - chemically induced; Purpura, Thrombotic Thrombocytopenic - diagnosis; Purpura, Thrombotic Thrombocytopenic - immunology; Purpura, Thrombotic Thrombocytopenic - therapy; South/Central America; Thrombocytopenia - chemically induced; Thrombocytopenia - diagnosis; Thrombocytopenia - immunology; Thrombocytopenia - therapy; Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions; Urinary tract infections; Urinary Tract Infections - drug therapy; Urinary Tract Infections - immunology
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2012-006507

Patients with systemic lupus erythematosus (SLE) may develop thrombotic thrombocytopaenic purpura (TTP) or TTP-like illness manifested by microangiopathic haemolytic anaemia (MAHA) and thrombocytopaenia. The distinction between active SLE and TTP is difficult because these entities share similar clinical features. Drug-induced TTP caused by an immune-mediated reaction have been documented for several drugs. Herein, we report a middle-aged Hispanic woman with long-standing SLE, who developed a TTP-like illness characterised by MAHA and thrombocytopaenia after exposure to nitrofurantoin. The patient responded well to plasmapheresis and immunosuppressive therapy and has remained clinically stable after 18 months of follow-up. To our knowledge, this is the first case that reports the association between nitrofurantoin and a TTP-like presentation.