Perindopril/amlodipine-induced thrombotic microangiopathy

Area of Science:

• Nephrology
• Hematology
• Pharmacology

Background:

• Thrombotic microangiopathy (TMA) is a rare but serious condition.
• Perindopril/amlodipine is a common antihypertensive medication.
• Drug-induced TMA is a recognized, albeit infrequent, adverse effect of some medications.

Observation:

• A 48-year-old female presented with rash, hematuria, weakness, hemiparesis, somnolence, and aphasia.
• Laboratory results indicated microangiopathic hemolytic anemia and thrombocytopenia.
• Symptoms emerged shortly after initiating perindopril/amlodipine therapy.

Findings:

• The patient was diagnosed with perindopril/amlodipine-induced thrombotic microangiopathy (TMA).
• The clinical presentation and timing suggested an acute, immune-mediated drug reaction.
• Hematologic abnormalities are rare but documented side effects of perindopril/amlodipine.

Implications:

• This is the first reported case of perindopril/amlodipine-induced TMA.
• Prompt diagnosis and withdrawal of the offending drug, alongside treatment (plasma exchange, corticosteroids), can lead to full recovery.
• Clinicians should consider TMA in patients presenting with relevant symptoms after starting perindopril/amlodipine.