Division of Renal Diseases and Hypertension, Department of Internal Medicine, University of Texas Health Science Center-McGovern Medical School, 6410 Fannin St, Houston, TX, 77030, USA.
Department of Pathology, The University of Texas Health Science Center-McGovern Medical School, Houston, TX, USA.
CEN Case Rep. 2022 Aug;11(3):321-327. doi: 10.1007/s13730-021-00681-z. Epub 2022 Jan 7.
Thrombotic microangiopathy (TMA) in a cancer patient is a common complication of either cancer itself or anticancer therapy. Incidence of TMA from anticancer therapy was found to be > 15%, since the introduction of anti-angiogenic drugs like anti-vascular endothelial growth factor agents. It is, however, important to not ignore other causes of TMA such as bacteria, viruses, antiplatelet drugs, hereditary complement mutations, and autoimmune disorders. We present such a diagnostic dilemma in our patient who was admitted with influenza and was found to have TMA on renal biopsy, while on proteasome inhibitor (PI) therapy. With this case, we would like to highlight the importance of understanding the true cause of TMA to avoid unwarranted long-term discontinuation of life saving anti-cancer drugs after TMA resolution.
癌症患者的血栓性微血管病（TMA）是癌症本身或抗癌治疗的常见并发症。自从抗血管内皮生长因子等抗血管生成药物问世以来，人们发现 TMA 的发病率>15%。然而，重要的是不要忽视其他导致 TMA 的原因，如细菌、病毒、抗血小板药物、遗传性补体突变和自身免疫性疾病。我们在一位因流感入院的患者中遇到了这样的诊断难题，在接受蛋白酶体抑制剂（PI）治疗时，肾活检发现 TMA。通过这个病例，我们想强调了解 TMA 真正原因的重要性，以避免在 TMA 缓解后不必要地长期停止使用救命的抗癌药物。
