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Related Experiment Videos

Quinine induced HUS-TTP: an unusual presentation.

Rajendra S Baliga1, C S Wingo

  • 1Department of Internal Medicine, University of Florida & The Malcolm Randall VA Medical Center, Gainsville, Florida 32608, USA. baligar@medicine.ufl.edu

The American Journal of the Medical Sciences
|December 13, 2003
PubMed
Summary

Re-exposure to quinine can trigger severe hemolytic uremic syndrome-like illness, even decades after initial use. This case highlights the potential for delayed, severe reactions to quinine, emphasizing careful patient history.

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Area of Science:

  • Pharmacology
  • Nephrology
  • Hematology

Background:

  • Quinine is an antimalarial and antipyretic drug, also used off-label for nocturnal leg cramps.
  • Adverse reactions to quinine can range from mild gastrointestinal upset to severe hematological and renal complications.
  • Previous exposure to quinine is a known risk factor for developing quinine-induced hypersensitivity reactions.

Observation:

  • A 67-year-old woman presented with severe gastrointestinal symptoms, blurred vision, and syncope after a single dose of quinine.
  • Clinical examination revealed fever, hypertension, and confusion. Laboratory findings included elevated liver enzymes, anemia, thrombocytopenia, and acute renal failure.
  • Peripheral blood smear showed schistocytes and burr cells, indicative of microangiopathic hemolytic anemia.

Findings:

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  • The patient had a history of quinine use over 40 years prior.
  • Diagnosis of a quinine-induced hemolytic uremic syndrome-thrombotic thrombocytopenic purpura (HUS-TTP) like syndrome was made.
  • Treatment with plasmapheresis led to rapid hematological recovery, while renal function required temporary dialysis support.

Implications:

  • This case demonstrates a rare and severe delayed hypersensitivity reaction to quinine re-exposure.
  • It underscores the importance of a thorough medication history, including remote exposures, in diagnosing complex syndromes.
  • The findings suggest that even a single, low-dose exposure to quinine can sensitize individuals, leading to severe HUS-TTP-like reactions upon subsequent re-exposure years later.