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[Mitomycin-induced hemolytic-uremic syndrome].

G Zeller1, E Wandel, A Schwarting

  • 1I. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz.

Deutsche Medizinische Wochenschrift (1946)
|June 19, 2003
PubMed
Summary

Mitomycin C chemotherapy can cause severe kidney damage, leading to hemolytic uremic syndrome. Prompt diagnosis and treatment with plasma separation and corticosteroids are crucial for recovery, especially when lung involvement occurs.

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Area of Science:

  • Nephrology
  • Oncology
  • Hematology

Background:

  • A 58-year-old patient developed rapidly progressive renal insufficiency and significant weight loss three months post-adjuvant chemotherapy for lower bowel carcinoma.
  • The patient presented with anuria, pulmonary edema, hemolytic anemia, and thrombocytopenia upon hospitalization.

Observation:

  • A 58-year-old patient developed rapidly progressive renal insufficiency, hemolytic anemia, thrombocytopenia, and pulmonary edema three months post-mitomycin C treatment.
  • Renal biopsy showed mesangiolysis and onion-skinning, indicative of thrombotic microangiopathy. Bone marrow examination revealed toxic damage.

Findings:

  • The patient presented with anuria, pulmonary hemorrhage, hemolytic anemia, and thrombocytopenia, consistent with severe HUS.
  • Computed tomography and bronchial endoscopy confirmed pulmonary hemorrhage, while renal biopsy revealed characteristic changes of HUS.

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Implications:

  • Pulmonary involvement in HUS is rare and associated with high mortality, necessitating prompt and accurate diagnosis.
  • Plasma separation and high-dose corticosteroid therapy led to recovery, highlighting their efficacy in managing severe HUS.
  • Dose adaptation of mitomycin C is essential in patients with renal impairment to prevent dose-dependent toxicity and avoid HUS.