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Thrombotic microangiopathy associated with intravenous injection of extended-release oxycodone

Kate J Robson1, Danielle Clucas2, Robin Filshie3

  • 1Department of Nephrology, Western Health, Melbourne, Australia.

BMJ Case Reports
|July 19, 2017
PubMed

Insights

Intravenous misuse of extended-release oxycodone hydrochloride (Oxycontin) can cause thrombotic microangiopathy (TMA). This case highlights diagnostic challenges and the potential role of eculizumab in managing drug-associated TMA.

Area of Science:

  • Nephrology
  • Toxicology
  • Hematology

Background:

  • Thrombotic microangiopathy (TMA) is a serious condition.
  • Intravenous misuse of extended-release medications poses unique risks.
  • Tamper-resistant formulations may lead to novel routes of abuse.

Observation:

  • A 35-year-old man developed TMA and renal impairment after injecting oral Oxycontin.
  • The patient experienced relapsing TMA despite treatment with eculizumab.
  • Previous cases of TMA linked to intravenous misuse of extended-release oxymorphone (Opana ER) and Oxycontin have been reported.

Findings:

  • This is the first documented case of TMA associated with intravenous Oxycontin misuse where eculizumab was administered.
  • Recurrent TMA was observed despite eculizumab treatment, suggesting limited efficacy in this context.
  • Diagnostic challenges in identifying TMA disorders are highlighted.

Implications:

  • Emphasizes the critical importance of obtaining a thorough drug history in patients presenting with TMA.
  • Raises questions about the efficacy of eculizumab in managing drug-induced TMA.
  • Underscores the need for further research into the mechanisms and management of TMA associated with prescription opioid misuse.
Keywords:
acute renal failuredrug misuse (including addiction)haematology (drugs and medicines)haematology (incl blood transfusion)unwanted effects / adverse reactions

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