Interferon-α-2b
1
Reactions 1149 - 28 Apr 2007 S Interferon-α-2b Haemolytic uraemic syndrome and acute mesenteric ischaemia: case report A 44-year-old woman developed haemolytic uraemic syndrome and acute mesenteric ischaemia during treatment with interferon-α-2b for HIV-associated Kaposi’s sarcoma. The woman started receiving interferon-α-2b 5 MU/m 2 /day and, 48 hours later, developed a fever of 38.2°C and confusion. Nine days after interferon initiation, she was transferred to an ICU due to severe hyperkalaemia (6.4 mmol/L), associated with anuric renal failure, which progressively worsened over a period of 4 days. She had the following levels: serum creatinine 368 µmol/L, proteinuria 1.2 g/L and urea 23 mol/L [sic]. Her platelet count decreased to 172 000/mm 3 . She also had haemolytic anaemia with very low haptoglobin levels and a haemoglobin level of 6.8 g/dL. Interferon-α-2b was discontinued and, within 72 hours, her condition improved. After receiving furosemide, diuresis restarted and her renal function improved with normalisation of creatinine levels; however, proteinuria (3.2 g/24h) and haemolytic anaemia persisted. Her platelet count decreased to 72 000/mm 3 . Three days after interferon discontinuation, she reported abdominal pain, vomiting and diarrhoea; there was guarding at her right periumbilical area and her abdomen was distended and painful. An abdominal and pelvic scan revealed a large amount of ascites with thickening of the walls of her small intestine. Puncture showed that the ascitic fluid was an exudate with 97% endothelial cells. She had increased amylase, serum lipase and lactate dehydrogenase (LDH) levels. Following aspiration through a nasogastric tube, her clinical condition and laboratory test results improved and, after 3 weeks, her pancreatic enzyme levels, LDH levels, platelet counts and proteinuria had normalised. In 1 month, her anaemia regressed and haptoglobin levels normalised. Immunological testing showed weakly positive anticardiolipin antibodies at a level of 14, and nuclear factors at a titre of 1:160 with speckled aspect. Author comment: Haemolytic uraemic syndrome was attributed to interferon-α. The interval of a few days until appearance of the symptoms was compatible with the data in the literature. Interferon may also have exerted toxicity at the level of the renal and mesenteric vessels. Zaraa I, et al. Haemolytic uremic syndrome and acute mesenteric ischemia caused by interferon-alpha-2b in the treatment of Kaposi’s sarcoma in an AIDS patient. Annales de Dermatologie et de Venereologie 134: 65-67, No. 1, Jan 2007 [French; summarised from a translation] - France 801070941 1 Reactions 28 Apr 2007 No. 1149 0114-9954/10/1149-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Interferon-α-2b
Reactions 1149 - 28 Apr 2007
SInterferon-α-2b
Haemolytic uraemic syndrome and acutemesenteric ischaemia: case report
A 44-year-old woman developed haemolytic uraemicsyndrome and acute mesenteric ischaemia during treatmentwith interferon-α-2b for HIV-associated Kaposi’s sarcoma.
The woman started receiving interferon-α-2b 5 MU/m2/dayand, 48 hours later, developed a fever of 38.2°C andconfusion. Nine days after interferon initiation, she wastransferred to an ICU due to severe hyperkalaemia(6.4 mmol/L), associated with anuric renal failure, whichprogressively worsened over a period of 4 days. She had thefollowing levels: serum creatinine 368 µmol/L, proteinuria1.2 g/L and urea 23 mol/L [sic]. Her platelet count decreased to172 000/mm3. She also had haemolytic anaemia with very lowhaptoglobin levels and a haemoglobin level of 6.8 g/dL.
Interferon-α-2b was discontinued and, within 72 hours, hercondition improved. After receiving furosemide, diuresisrestarted and her renal function improved with normalisationof creatinine levels; however, proteinuria (3.2 g/24h) andhaemolytic anaemia persisted. Her platelet count decreased to72 000/mm3. Three days after interferon discontinuation, shereported abdominal pain, vomiting and diarrhoea; there wasguarding at her right periumbilical area and her abdomen wasdistended and painful. An abdominal and pelvic scan revealeda large amount of ascites with thickening of the walls of hersmall intestine. Puncture showed that the ascitic fluid was anexudate with 97% endothelial cells. She had increasedamylase, serum lipase and lactate dehydrogenase (LDH)levels. Following aspiration through a nasogastric tube, herclinical condition and laboratory test results improved and,after 3 weeks, her pancreatic enzyme levels, LDH levels,platelet counts and proteinuria had normalised. In 1 month,her anaemia regressed and haptoglobin levels normalised.Immunological testing showed weakly positive anticardiolipinantibodies at a level of 14, and nuclear factors at a titre of1:160 with speckled aspect.
Author comment: Haemolytic uraemic syndrome wasattributed to interferon-α. The interval of a few days untilappearance of the symptoms was compatible with the data inthe literature. Interferon may also have exerted toxicity at thelevel of the renal and mesenteric vessels.Zaraa I, et al. Haemolytic uremic syndrome and acute mesenteric ischemia causedby interferon-alpha-2b in the treatment of Kaposi’s sarcoma in an AIDS patient.Annales de Dermatologie et de Venereologie 134: 65-67, No. 1, Jan 2007 [French;summarised from a translation] - France 801070941
1
Reactions 28 Apr 2007 No. 11490114-9954/10/1149-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
