Wang Song, Liu Huan, Wei Wei, Zhang Yu-Lu, Huang Lei
Department of Heart Center, the Third Central Hospital of Tianjin, Tianjin, China.
Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China.
AME Case Rep. 2025 Jul 15;9:94. doi: 10.21037/acr-24-247. eCollection 2025.
Thrombotic microangiopathy (TMA) is a rare, life-threatening syndrome characterized by microvascular thrombosis, hemolytic anemia, thrombocytopenia, and organ dysfunction. While it can be induced by infections, drugs, malignancies, autoimmune disorders, or genetic defects, TMA is particularly uncommon in second breast cancer (SBC) patients with a history of Hodgkin lymphoma (HL).
We describe a 45-year-old female who developed metastatic SBC 18 years after curative HL treatment. The diagnosis of TMA was established on the basis of thrombocytopenia, hemolytic anemia (elevated lactate dehydrogenase, low haptoglobin, and a reticulocyte count of 5.72%), and multi-organ dysfunction, following the exclusion of thrombotic thrombocytopenic purpura and Shiga toxin-producing (STEC)-hemolytic uremic syndrome. In this case, the multifactorial etiology-stemming from both paraneoplastic endothelial injury and chemotherapy-induced toxicity-complicated the clinical picture. Despite aggressive supportive measures, including plasma exchange and antibiotics, the patient's condition rapidly deteriorated, culminating in fatal cerebral hemorrhage.
This case highlights the diagnostic and therapeutic challenges of TMA in patients with complex oncologic histories, as exemplified by its rare occurrence in a patient with SBC post-HL. Although supportive care remains paramount, our findings suggest that complement inhibition with eculizumab may offer benefits in select cases, such as chemotherapy-induced and paraneoplastic TMA. Early detection and targeted intervention are crucial, warranting further research into eculizumab's potential role in high-risk settings.
血栓性微血管病（TMA）是一种罕见的、危及生命的综合征，其特征为微血管血栓形成、溶血性贫血、血小板减少和器官功能障碍。虽然它可由感染、药物、恶性肿瘤、自身免疫性疾病或遗传缺陷诱发，但TMA在有霍奇金淋巴瘤（HL）病史的继发性乳腺癌（SBC）患者中尤为罕见。
我们描述了一名45岁女性，在接受HL根治性治疗18年后发生转移性SBC。在排除血栓性血小板减少性紫癜和产志贺毒素（STEC）溶血性尿毒症综合征后，根据血小板减少、溶血性贫血（乳酸脱氢酶升高、触珠蛋白降低以及网织红细胞计数为5.72%）和多器官功能障碍确诊为TMA。在该病例中，源于副肿瘤性内皮损伤和化疗诱导毒性的多因素病因使临床情况复杂化。尽管采取了积极的支持措施，包括血浆置换和使用抗生素，但患者病情迅速恶化，最终死于脑出血。
本病例突出了TMA在有复杂肿瘤病史患者中的诊断和治疗挑战，例如在HL后发生SBC的患者中罕见发生。尽管支持治疗仍然至关重要，但我们的研究结果表明，在某些情况下，如化疗诱导和副肿瘤性TMA，使用依库珠单抗抑制补体可能有益。早期检测和靶向干预至关重要，有必要进一步研究依库珠单抗在高危情况下的潜在作用。
