Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2018; 6(12): 531-537
Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.531
Gemcitabine-induced haemolytic uremic syndrome, although infrequent, can it be prevented: A case report and review of literature
Esther U Cidon, Pilar A Martinez, Tamas Hickish
Esther U Cidon, Department of Medical Oncology, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust, Bournemouth BH7 7DW, United Kingdom
Pilar A Martinez, Department of Oncology, Clinical University Hospital, Valladolid 47003, Spain
Tamas Hickish, Department of Medical Oncology, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust and Bournemouth University, Bournemouth BH7 7DW, United Kingdom
Author contributions: Cidon EU contributed to the conception of this paper and design of the article; Cidon EU and Martinez PA equally contributed to the literature review and analysis, drafting, critical revision and editing, and approval of the final version; Hickish T has contributed to critical revision, approval of the final version and as English native speaker, has reviewed and edited the language when needed.
Informed consent statement: Informed consent to publish was obtained from the patient.
Conflict-of-interest statement: The authors state that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Esther U Cidon, MD, MSc, PhD, Doctor, Department of Medical Oncology, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust, Castle Lane East, Bournemouth BH7 7DW, United Kingdom. esther.unacidon@rbch.nhs.uk
Telephone: +44-1202-303626 Fax: +44-1202-704467
Received: May 5, 2018
Peer-review started: May 5, 2018
First decision: July 9, 2018
Revised: September 8, 2018
Accepted: October 9, 2018
Article in press: October 9, 2018
Published online: October 26, 2018
Abstract

Gemcitabine is an antineoplastic used to treat several malignancies including pancreatic cancer. Its toxicity profile is well known with myelotoxicity, increased vascular permeability and peripheral oedema as most frequent adverse events. However, several cases of acute renal failure have been reported and haemolytic uremic syndrome (HUS) seems to be the underlying process. The cause of HUS remains unknown but its consequences can be lethal. Therefore, a high grade of suspicion is crucial to diagnose it and promptly treat it. This hopefully will reduce its morbidity. HUS is characterized by progressive renal failure associated with microangiopathic haemolytic anaemia and thrombocytopenia. The primary event is damage to endothelial cells and thrombotic microangiopathy (TMA) is the histopathological lesion. TMA affects mainly renal microvasculature. However, some cases evolve with central nervous or cardiovascular systems involvement. We present here a case of gemcitabine-induced HUS, with renal and cardiovascular system affected at the time of diagnosis which to our knowledge this is the first time of such case to be reported.

Keywords: Thrombocytopenia, Haemolytic uremic syndrome, Thrombotic microangiopathy, Gemcitabine, Microangiopathic haemolytic anaemia

Core tip: Gemcitabine has a well-known toxicity profile though rare cases of acute renal failure caused by haemolytic uremic syndrome (HUS) have also been reported. The cause of HUS remains unknown but its consequences may be lethal. HUS consists of progressive renal failure with microangiopathic haemolytic anaemia and thrombocytopenia. Thrombotic microangiopathy is the histopathological lesion and this affects mainly renal microvasculature. We present a case of gemcitabine-induced HUS and review literature to make professionals fully aware of its existence, thus a high grade of suspicion might help with early diagnosis and prompt treatment which hopefully will reduce its morbidity.