Nephrology Department, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
Nanchang University, Nanchang, 330031, China.
J Med Case Rep. 2024 Jul 5;18(1):321. doi: 10.1186/s13256-024-04635-8.
Thrombotic microangiopathy is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ injury. The pathological features include vascular damage that is manifested by arteriolar and capillary thrombosis with characteristic abnormalities in the endothelium and vessel wall. Thrombocytopenia is one of the common adverse effects of interferon therapy. However, a more serious but rare side effect is thrombotic microangiopathy.
We report the case of a 36-year-old Asian male patient with clinical manifestations of hypertension, blurred vision, acute renal failure, thrombocytopenia, and thrombotic microangiopathy. Renal biopsy showed interstitial edema with fibrosis, arteriolar thickening with vitreous changes, and epithelial podocytes segmental fusion. Immunofluorescence microscopy showed C3(+), Ig A(+) deposition in the mesangial region, which was pathologically consistent with thrombotic microangiopathy renal injury and Ig A deposition. The patient had a history of hepatitis B virus infection for more than 5 years. Lamivudine was used in the past, but the injection of long-acting interferon combined with tenofovir alafenamide fumarate was used since 2018. The comprehensive clinical investigation and laboratory examination diagnosed the condition as thrombotic microangiopathy kidney injury caused by interferon. After stopping interferon in his treatment, the patient's renal function partially recovered after three consecutive therapeutic plasma exchange treatments and follow-up treatment without immunosuppressant. The renal function of the patient remained stable.
This report indicates that interferon can induce thrombotic microangiopathy with acute renal injury, which can progress to chronic renal insufficiency.
血栓性微血管病的特征是微血管性溶血性贫血、血小板减少和器官损伤。病理特征包括血管损伤，表现为小动脉和毛细血管血栓形成，内皮细胞和血管壁有特征性异常。血小板减少是干扰素治疗的常见不良反应之一。但是，更严重但罕见的副作用是血栓性微血管病。
我们报告了一例 36 岁亚裔男性患者，临床表现为高血压、视力模糊、急性肾衰竭、血小板减少和血栓性微血管病。肾活检显示间质水肿伴纤维化，小动脉增厚伴玻璃样变，上皮足细胞节段融合。免疫荧光显微镜显示 C3(+)、IgA(+)在系膜区沉积，病理表现符合血栓性微血管病肾损伤和 IgA 沉积。该患者有乙型肝炎病毒感染病史 5 年以上，既往使用拉米夫定，自 2018 年起使用长效干扰素联合富马酸替诺福韦酯。通过综合临床调查和实验室检查，诊断为干扰素引起的血栓性微血管病肾损伤。在治疗中停用干扰素后，患者肾功能在连续 3 次治疗性血浆置换治疗和无免疫抑制剂的后续治疗后部分恢复，患者的肾功能保持稳定。
本报告表明干扰素可诱发伴有急性肾损伤的血栓性微血管病，可进展为慢性肾功能不全。
