Zhang Su, Zhou Hai-Hui, Zhong Zi-Xing, Wang Qi-Qi, Huang Ping, Liu Su-Xiao
Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
Center for Reproductive Medicine, Department of Obstetrics, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
SAGE Open Med Case Rep. 2025 Jan 4;13:2050313X241308693. doi: 10.1177/2050313X241308693. eCollection 2025.
Cyclosporine A (CsA) is a commonly used immunosuppressant, but its association with thrombotic microangiopathy (TMA) is rarely reported. In recent years, CsA has been used in pregnant women with autoimmune diseases or previous immune-related adverse pregnancies. Our case involves a 34-year-old female who developed typical laboratory indicators of TMA while using CsA to improve pregnancy outcomes. After discontinuing CsA, the TMA markers gradually normalized. To our knowledge, this is the first report of CsA-induced TMA during pregnancy. We also reviewed previous case reports of CsA-induced TMA and summarized the possible mechanisms, characteristics, and risk factors, as well as methods to identify this rare adverse effect of CsA in pregnant women.
环孢素A(CsA)是一种常用的免疫抑制剂,但其与血栓性微血管病(TMA)的关联鲜有报道。近年来,CsA已被用于患有自身免疫性疾病或既往有免疫相关不良妊娠史的孕妇。我们的病例涉及一名34岁女性,她在使用CsA改善妊娠结局时出现了典型的TMA实验室指标。停用CsA后,TMA标志物逐渐恢复正常。据我们所知,这是首例关于孕期CsA诱发TMA的报道。我们还回顾了既往CsA诱发TMA的病例报告,并总结了可能的机制、特征、危险因素,以及识别CsA在孕妇中这种罕见不良反应的方法。