THROMBOTIC MICROANGIOPATHY ASSOCIATED WITH OPANA ER INTRAVENOUS ABUSE A Case Report

Area of Science:

• Nephrology
• Hematology
• Toxicology

Background:

• Thrombotic microangiopathy (TMA) involves endothelial damage and small blood vessel narrowing.
• Secondary TMA can arise from various conditions including pregnancy, infections, autoimmune diseases, and certain drugs.
• Recent reports link a reformulated Opana ER (oxymorphone extended-release) to TMA when administered intravenously.

Observation:

• A 37-year-old male presented with acute kidney injury and hemolytic anemia.
• The patient reported a history of intravenous abuse of reformulated Opana ER.
• Clinical presentation and laboratory findings were suggestive of TMA.

Findings:

• Renal biopsy confirmed pathological changes consistent with thrombotic microangiopathy.
• The findings strongly suggest Opana ER intravenous abuse as the causative agent for the observed TMA.
• This case adds to the evidence linking reformulated Opana ER injection to severe TMA.

Implications:

• Intravenous Opana ER abuse poses a significant risk for developing severe thrombotic microangiopathy.
• Physicians should consider Opana ER abuse in patients presenting with unexplained TMA, particularly with renal and hematologic compromise.
• This underscores the critical need for awareness regarding the potential thrombotic risks associated with the intravenous misuse of reformulated opioid medications.