Newton Joseph, Floyd Lauren, Ponnusamy Arvind, Anderton John
Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, and.
Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, Lancashire, UK.
Clin Nephrol Case Stud. 2021 Sep 10;9:105-109. doi: 10.5414/CNCS110609. eCollection 2021.
An 86-year-old man returned to the UK from Spain with symptoms suggestive of gastrointestinal bleeding. He was found to have an acute kidney injury and thrombocytopenia. Further investigations identified the presence of a microangiopathic hemolytic anemia, supporting the diagnosis of a thrombotic microangiopathy. Differentials included atypical hemolytic uremic syndrome and secondary thrombotic microangiopathy. Thrombotic thrombocytopenic purpura (TTP) and STEC (Shiga toxin-producing ) hemolytic uremic syndrome were excluded by a normal ADAMTS-13 and negative serology and stool PCR. The patient was treated with blood and platelet transfusions. He received eculizumab and hemodialysis whilst a screen for secondary causes was undertaken. Thrombotic microangiopathy was shown to be secondary to recurrence of prostate cancer, which had been treated 16 years previously. He later recovered his renal function and receives ongoing hormonal treatment for his prostate cancer.
一名86岁男性从西班牙返回英国，出现提示胃肠道出血的症状。他被发现患有急性肾损伤和血小板减少症。进一步检查发现存在微血管病性溶血性贫血，支持血栓性微血管病的诊断。鉴别诊断包括非典型溶血性尿毒症综合征和继发性血栓性微血管病。通过正常的ADAMTS-13、阴性血清学检查和粪便PCR排除了血栓性血小板减少性紫癜（TTP）和产志贺毒素大肠杆菌（STEC）溶血性尿毒症综合征。患者接受了输血和血小板输注治疗。在进行继发性病因筛查时，他接受了依库珠单抗和血液透析治疗。结果显示，血栓性微血管病是由16年前接受过治疗的前列腺癌复发所致。他后来肾功能恢复，目前正在接受前列腺癌的激素治疗。
