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Related Experiment Video

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Facile Preparation of 4-Substituted Quinazoline Derivatives

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Published on: February 15, 2016

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

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:

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.