Association of thrombotic microangiopathy with interferon therapy for hepatitis B: a case report.
Interferon
Renal injury
Thrombotic microangiopathy (TMA)
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
05 Jul 2024
05 Jul 2024
Historique:
received:
03
01
2024
accepted:
02
06
2024
medline:
5
7
2024
pubmed:
5
7
2024
entrez:
4
7
2024
Statut:
epublish
Résumé
Thrombotic microangiopathy is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ injury. The pathological features include vascular damage that is manifested by arteriolar and capillary thrombosis with characteristic abnormalities in the endothelium and vessel wall. Thrombocytopenia is one of the common adverse effects of interferon therapy. However, a more serious but rare side effect is thrombotic microangiopathy. We report the case of a 36-year-old Asian male patient with clinical manifestations of hypertension, blurred vision, acute renal failure, thrombocytopenia, and thrombotic microangiopathy. Renal biopsy showed interstitial edema with fibrosis, arteriolar thickening with vitreous changes, and epithelial podocytes segmental fusion. Immunofluorescence microscopy showed C3(+), Ig A(+) deposition in the mesangial region, which was pathologically consistent with thrombotic microangiopathy renal injury and Ig A deposition. The patient had a history of hepatitis B virus infection for more than 5 years. Lamivudine was used in the past, but the injection of long-acting interferon combined with tenofovir alafenamide fumarate was used since 2018. The comprehensive clinical investigation and laboratory examination diagnosed the condition as thrombotic microangiopathy kidney injury caused by interferon. After stopping interferon in his treatment, the patient's renal function partially recovered after three consecutive therapeutic plasma exchange treatments and follow-up treatment without immunosuppressant. The renal function of the patient remained stable. This report indicates that interferon can induce thrombotic microangiopathy with acute renal injury, which can progress to chronic renal insufficiency.
Sections du résumé
BACKGROUND
BACKGROUND
Thrombotic microangiopathy is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ injury. The pathological features include vascular damage that is manifested by arteriolar and capillary thrombosis with characteristic abnormalities in the endothelium and vessel wall. Thrombocytopenia is one of the common adverse effects of interferon therapy. However, a more serious but rare side effect is thrombotic microangiopathy.
CASE PRESENTATION
METHODS
We report the case of a 36-year-old Asian male patient with clinical manifestations of hypertension, blurred vision, acute renal failure, thrombocytopenia, and thrombotic microangiopathy. Renal biopsy showed interstitial edema with fibrosis, arteriolar thickening with vitreous changes, and epithelial podocytes segmental fusion. Immunofluorescence microscopy showed C3(+), Ig A(+) deposition in the mesangial region, which was pathologically consistent with thrombotic microangiopathy renal injury and Ig A deposition. The patient had a history of hepatitis B virus infection for more than 5 years. Lamivudine was used in the past, but the injection of long-acting interferon combined with tenofovir alafenamide fumarate was used since 2018. The comprehensive clinical investigation and laboratory examination diagnosed the condition as thrombotic microangiopathy kidney injury caused by interferon. After stopping interferon in his treatment, the patient's renal function partially recovered after three consecutive therapeutic plasma exchange treatments and follow-up treatment without immunosuppressant. The renal function of the patient remained stable.
CONCLUSIONS
CONCLUSIONS
This report indicates that interferon can induce thrombotic microangiopathy with acute renal injury, which can progress to chronic renal insufficiency.
Identifiants
pubmed: 38965631
doi: 10.1186/s13256-024-04635-8
pii: 10.1186/s13256-024-04635-8
doi:
Substances chimiques
Antiviral Agents
0
Interferons
9008-11-1
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
321Subventions
Organisme : National Natural Science Foundation of China
ID : no.81760129)
Informations de copyright
© 2024. The Author(s).
Références
Ruggenenti P, Noris M, Remuzzi G. Thrombotic microangiopathy, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura. Kidney Int. 2001;60(3):831–46.
doi: 10.1046/j.1523-1755.2001.060003831.x
pubmed: 11532079
Markowitz GS, Nasr SH, Stokes MB, D’Agati VD. Treatment with IFN-{alpha}, -{beta}, or -{gamma} is associated with collapsing focal segmental glomerulosclerosis. Clin J Am Soc Nephrol. 2010;5(4):607–15.
doi: 10.2215/CJN.07311009
pubmed: 20203164
pmcid: 2849683
Trimarchi H, Coppo R. Glomerular endothelial activation, C4d deposits and microangiopathy in immunoglobulin A nephropathy. Nephrol Dial Transplant. 2021;36(4):581–6.
doi: 10.1093/ndt/gfz241
pubmed: 31755918
Fahal IH, Murry N, Chu P, Bell GM. Acute renal failure during interferon treatment. BMJ. 1993;306(6883):973.
doi: 10.1136/bmj.306.6883.973
pubmed: 8490476
pmcid: 1677459
Abbott IJ, Chang CC, Skinner MJ, Street A, Perry G, McLean C, et al. Development and management of systemic lupus erythematosus in an HIV-infected man with hepatitis C and B co-infection following interferon therapy: a case report. J Med Case Rep. 2009;3:7289.
doi: 10.4076/1752-1947-3-7289
pubmed: 19830165
pmcid: 2726516
Honda K, Ando A, Endo M, Shimizu K, Higashihara M, Nitta K, et al. Thrombotic microangiopathy associated with alpha-interferon therapy for chronic myelocytic leukemia. Am J Kidney Dis. 1997;30(1):123–30.
doi: 10.1016/S0272-6386(97)90575-8
pubmed: 9214412
Badid C, McGregor B, Faivre JM, Guerard A, Juillard L, Fouque D, et al. Renal thrombotic microangiopathy induced by interferon-alpha. Nephrol Dial Transplant. 2001;16(4):846–8.
doi: 10.1093/ndt/16.4.846
pubmed: 11274286
Magee CC. Renal thrombotic microangiopathy induced by interferon-alpha. Nephrol Dial Transplant. 2001;16(10):2111–2.
doi: 10.1093/ndt/16.10.2111-a
pubmed: 11572913
Lotta LA, Degasperi E, Aghemo A, Ferrari B, Peyvandi F, Colombo M. Treatment of chronic hepatitis C with pegylated interferon-α in a patient with recurrent autoimmune thrombotic thrombocytopenic purpura. Transfus Med. 2013;23(1):66–8.
doi: 10.1111/j.1365-3148.2012.01197.x
pubmed: 23106108
Fox LC, Cohney SJ, Kausman JY, Shortt J, Hughes PD, Wood EM, et al. Consensus opinion on diagnosis and management of thrombotic microangiopathy in Australia and New Zealand. Intern Med J. 2018;48(6):624–36.
doi: 10.1111/imj.13804
pubmed: 29582550
Kundra A, Wang JC. Interferon induced thrombotic microangiopathy (TMA): analysis and concise review. Crit Rev Oncol Hematol. 2017;112:103–12.
doi: 10.1016/j.critrevonc.2017.02.011
pubmed: 28325251
Walther EU, Hohlfeld R. Multiple sclerosis: side effects of interferon beta therapy and their management. Neurology. 1999;53(8):1622–7.
doi: 10.1212/WNL.53.8.1622
pubmed: 10563602
Costelloe SJ, Wassef N, Schulz J, Vaghijiani T, Morris C, Whiting S, et al. Thyroid dysfunction in a UK hepatitis C population treated with interferon-alpha and ribavirin combination therapy. Clin Endocrinol (Oxf). 2010;73(2):249–56.
doi: 10.1111/j.1365-2265.2010.03785.x
pubmed: 20148905
Broughton A, Cosyns JP, Jadoul M. Thrombotic microangiopathy induced by long-term interferon-β therapy for multiple sclerosis: a case report. Clin Nephrol. 2011;76(5):396–400.
doi: 10.5414/CN106523
pubmed: 22000560
Galesic K, Bozic B, Racic I, Scukanec-Spoljar M. Thrombotic microangiopathy associated with alpha-interferon therapy for chronic myeloid leukaemia. Nephrology (Carlton). 2006;11(1):49–52.
doi: 10.1111/j.1440-1797.2006.00524.x
pubmed: 16509932
Mahe J, Meurette A, Moreau A, Vercel C, Jolliet P. Renal thrombotic microangiopathy caused by interferon beta-1a treatment for multiple sclerosis. Drug Des Devel Ther. 2013;7:723–8.
doi: 10.2147/DDDT.S42138
pubmed: 23950639
pmcid: 3741076
George JN, Terrell DR, Vesely SK, Kremer Hovinga JA, Lämmle B. Thrombotic microangiopathic syndromes associated with drugs, HIV infection, hematopoietic stem cell transplantation and cancer. Presse Med. 2012;41(3 Pt 2):e177–88.
doi: 10.1016/j.lpm.2011.10.026
pubmed: 22244728
Campistol JM, Arias M, Ariceta G, Blasco M, Espinosa L, Espinosa M, et al. An update for atypical haemolytic uraemic syndrome: diagnosis and treatment. A consensus document Nefrologia. 2015;35(5):421–47.
pubmed: 26456110
Sadler JE. What’s new in the diagnosis and pathophysiology of thrombotic thrombocytopenic purpura. Hematology Am Soc Hematol Educ Program. 2015;2015(1):631–6.
doi: 10.1182/asheducation-2015.1.631
pubmed: 26637781
Wu N, Liu J, Yang S, Kellett ET, Cataland SR, Li H, et al. Diagnostic and prognostic values of ADAMTS13 activity measured during daily plasma exchange therapy in patients with acquired thrombotic thrombocytopenic purpura. Transfusion. 2015;55(1):18–24.
doi: 10.1111/trf.12762
pubmed: 24953079
Scully M, Yarranton H, Liesner R, Cavenagh J, Hunt B, Benjamin S, et al. Regional UK TTP registry: correlation with laboratory ADAMTS 13 analysis and clinical features. Br J Haematol. 2008;142(5):819–26.
doi: 10.1111/j.1365-2141.2008.07276.x
pubmed: 18637802
Clark WF. Thrombotic microangiopathy: current knowledge and outcomes with plasma exchange. Semin Dial. 2012;25(2):214–9.
doi: 10.1111/j.1525-139X.2011.01035.x
pubmed: 22309967
Scully M, Hunt BJ, Benjamin S, Liesner R, Rose P, Peyvandi F, et al. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol. 2012;158(3):323–35.
doi: 10.1111/j.1365-2141.2012.09167.x
pubmed: 22624596
Sarode R, Bandarenko N, Brecher ME, Kiss JE, Marques MB, Szczepiorkowski ZM, et al. Thrombotic thrombocytopenic purpura: 2012 American Society for Apheresis (ASFA) consensus conference on classification, diagnosis, management, and future research. J Clin Apher. 2014;29(3):148–67.
doi: 10.1002/jca.21302
pubmed: 24136342
Page EE, Kremer Hovinga JA, Terrell DR, Vesely SK, George JN. Rituximab reduces risk for relapse in patients with thrombotic thrombocytopenic purpura. Blood. 2016;127(24):3092–4.
doi: 10.1182/blood-2016-03-703827
pubmed: 27060171
Noris M, Mescia F, Remuzzi G. STEC-HUS, atypical HUS and TTP are all diseases of complement activation. Nat Rev Nephrol. 2012;8(11):622–33.
doi: 10.1038/nrneph.2012.195
pubmed: 22986360
Loirat C, Fakhouri F, Ariceta G, Besbas N, Bitzan M, Bjerre A, et al. An international consensus approach to the management of atypical hemolytic uremic syndrome in children. Pediatr Nephrol. 2016;31(1):15–39.
doi: 10.1007/s00467-015-3076-8
pubmed: 25859752
Gourley BL, Mesa H, Gupta P. Rapid and complete resolution of chemotherapy-induced thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) with rituximab. Cancer Chemother Pharmacol. 2010;65(5):1001–4.
doi: 10.1007/s00280-010-1258-4
pubmed: 20119714
Murugapandian S, Bijin B, Mansour I, Daheshpour S, Pillai BG, Thajudeen B, et al. Improvement in gemcitabine-induced thrombotic microangiopathy with rituximab in a patient with ovarian cancer: mechanistic considerations. Case Rep Nephrol Dial. 2015;5(2):160–7.
doi: 10.1159/000435807
pubmed: 26266248
pmcid: 4519601