Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2023; 11(8): 1799-1807
Published online Mar 16, 2023. doi: 10.12998/wjcc.v11.i8.1799
Glucocorticoid-induced thrombotic microangiopathy in paroxysmal nocturnal hemoglobinuria: A case report and review of literature
Xiao-Dong Yang, Bo Ju, Jia Xu, Nuan-Nuan Xiu, Xiao-Yun Sun, Xi-Chen Zhao
Xiao-Dong Yang, Bo Ju, Jia Xu, Nuan-Nuan Xiu, Xiao-Yun Sun, Xi-Chen Zhao, Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Author contributions: Zhao XC developed the idea; Yang XD, Ju B and Xu J analyzed the data and drafted the manuscript; Yang XD, Ju B, Xu J and Xiu NN participated in the treatment; Sun XY supervised the treatment; and Zhao XC revised and approved the final manuscript; all authors have read and approved the final version of the manuscript.
Supported by Specialized Scientific Research Fund Projects of The Medical Group of Qingdao University, No. YLJT20201002.
Informed consent statement: Informed written consent was obtained from the patient for publishing this case report and any accompanying laboratory data.
Conflict-of-interest statement: The authors have no conflicts of interest to declare that are relevant to the content of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial license (CC BY-NC 4.0), which permits others to distribute, remix, adapt, build upon this work noncommercially and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. Please see https://creativecommons.org/Licenses/bync/4.0/
Corresponding author: Xi-Chen Zhao, MD, Chief Physician, Department of Hematology, The Central Hospital of Qingdao West Coast New Area, No. 9 Huangpujiang Road, Qingdao 266555, Shandong Province, China. zhaoxichen2003@163.com
Received: November 7, 2022
Peer-review started: November 7, 2022
First decision: November 25, 2022
Revised: December 2, 2022
Accepted: February 8, 2023
Article in press: February 8, 2023
Published online: March 16, 2023
Processing time: 119 Days and 19 Hours
Core Tip

Core Tip: Glucocorticoid-associated thrombotic microangiopathy has rarely been reported. Here, we report a patient with paroxysmal nocturnal hemoglobinuria whose hematological parameters worsened during methylprednisolone treatment, and increasing methylprednisolone doses further exacerbated the cytopenia. Observation of platelet transfusion refractoriness suggested the possibility of thrombotic microangiopathy development. Significant hematological improvement was achieved after discontinuation of methylprednisolone treatment, confirming that methylprednisolone treatment acted as the triggering factor to promote platelet aggregation within the microcirculation. Given the wide use of glucocorticoids in clinical practice and the high incidence of thrombocytopenia during glucocorticoid treatment, particular attention should be given to this potentially fatal complication.