Journal
CLINICAL KIDNEY JOURNAL
Volume 14, Issue 4, Pages 1275-1276Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ckj/sfaa101
Keywords
bleomycin; complement; eculizumab; lung fibrosis; thrombotic microangiopathy
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The article reports a rare case of a patient who developed TMA and acute respiratory distress syndrome after chemotherapy. Although eculizumab successfully treated TMA, the patient eventually progressed to refractory respiratory failure.
Whether C5 blocking may improve the outcomes of patients developing chemotherapy-induced thrombotic microangiopathy (TMA) remains elusive. Lung fibrosis is a well-known complication of bleomycin, whereas TMA5 are very rare (<20 cases described). Here, we report an exceptional case of a male patient that developed acute respiratory distress syndrome and TMA following administration of bleomycin, cisplatin and etoposide . Refractoriness to plasma exchanges prompted us to use eculizumab as salvage therapy. Eculizumab led to complete remission of the TMA before Day 2. However, the patient progressed towards refractory respiratory failure, suggesting that pathophysiological mechanisms of bleomycin-induced lung fibrosis and TMA differ.
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