MOSES C EZEAKILE1, TASNIM ZIRAPURY1
1Department of Nephrology, Division of Medicine, Rockhampton Hospital, Central Queensland Hospital and Health Services, Rockhampton, Australia
Biography:
Dr Moses Ezeakile is a second-year nephrology advanced trainee who is currently based at the Princess Alexandra Hospital in Brisbane. He completed a fellowship in general medicine in Aotearoa New Zealand before pursuing training in Nephrology. His areas of interest include general nephrology and interventional nephrology. He aspires to practice nephrology in regional settings and engage in research involving remote communities.
Background:
Intravenous (IV) injection of oral tamper-resistant formulation of modified release oxycodone (OxyContin®) has been reported to cause thrombotic microangiopathy (TMA). It is not known if withdrawal of the trigger alone is sufficient for management in severe cases.
Case Report:
35-year-old female, presenting with a six-day history of malaise, myalgia, vomiting, decreased urine output, and a reported episode of seizure-like activity. She had no diarrhoea, fever, or other focal infective symptoms. She was found to have anuric acute kidney injury with thrombotic microangiopathy. On admission, her laboratory results include creatinine 1410 µmol/L (45-90 µmol/L), Urea 71.1 mmol/L (2.1-7.1 mmol/L), Haemoglobin 80 g/L (115-160 g/L), Platelets 57×103/L (nadir) (140-400 x103/L), Lactate dehydrogenase (LDH) 1280 U/L (120-250 U/L), Total bilirubin 28 µmol/L (< 20 µmol/L) and Haptoglobin 0.15 g/L (0.36-1.95 g/L). She was commenced on haemodialysis until recovery of anuria. She also received one session of plasmapheresis (TPE), which was discontinued following the discovery that the patient had been crushing and injecting modified release oxycodone (OxyContin®) prior to the development of her symptoms. Her ADAMTS13 activity result was 94% (40-130%). Oxycodone was avoided during her hospitalization. There was complete normalization of her haematological parameters on discharge, 12 days later, and complete normalization of renal function at 6 months.
Conclusions:
Our case study suggests that complete renal recovery is attainable even in patients with severe renal impairment from thrombotic microangiopathy due to IV use of OxyContin® on prompt removal of the trigger. A high index of suspicion is essential for prompt diagnosis to avoid unnecessarily prolonged and invasive treatments.