Complete recovery of thrombotic microangiopathy with severe acute kidney injury due to intravenous use of modified release oxycodone

Since the introduction of the tamper-resistant oral formulation of modified-release oxycodone (OxyContin®), cases of thrombotic microangiopathy (TMA) have been reported following intravenous injection of the drug. Previous reports have suggested that withdrawal of the offending agent alone may be sufficient to reverse the condition; however, the associated acute kidney injury (AKI) in these cases was only mild to moderate in severity. We report the first case of OxyContin®-associated TMA presenting with anuric AKI requiring dialysis, followed by complete renal recovery after cessation of intravenous OxyContin® use. This case demonstrates that withdrawal of the causative agent may be sufficient to achieve resolution of TMA even in severe presentations. Accordingly, supportive management without the need for invasive and costly interventions may be appropriate in selected cases. Awareness of the association between intravenous OxyContin® use and TMA is essential for timely diagnosis, as identification often depends on direct inquiry regarding drug exposure.