Retinal Injury as an Early Manifestation of Posttransplant Thrombotic Microangiopathy: Recovery With Plasma Exchanges and Conversion to Sirolimus—Case Report and Review of the Literature

Mohsin, Nabil; Nooyi, C.; Jha, A.; Budruddin, M.; Kamble, Pramod; Khalil, M.; Pakkyarra, A.; Mohammed, Ehab; Ahmed, H.; Daar, Abdallah S.

doi:10.1016/j.transproceed.2007.03.086

Cited by 6 publications

(4 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thrombotic microangiopathy, presenting either as TTP or hemolytic uremic syndrome (HUS), has been described in 3 to 14% of RTX patients. TTP may also occur following hematopoietic stem cell, bone marrow, lung and cardiac transplantations [9]. It may develop just after transplantation or later on, as it happened in our patient.…”

Section: Discussionsupporting

confidence: 51%

Thrombotic thrombocytopenic purpura associated with everolimus use in a renal transplant patient

et al. 2010

View full text Add to dashboard Cite

Thrombotic microangiopathy (TMA) in renal transplantation (RTX) generally develops during treatment with calcineurin inhibitors. We present a RTX case that developed TMA under everolimus treatment. A 40-year-old woman received a kidney allograft from her 77-year-old mother. She initially received tacrolimus, mycophenolate mofetil and steroids. She was discharged with a creatinine level of 2.2 mg/dl after treatment for a cellular rejection attack within the first two weeks after transplantation. Later on, tacrolimus was replaced with everolimus. One year later, she presented with fever and increased creatinine level (4 mg/dl), anemia and thrombocytopenia. Her peripheral blood smear revealed signs of microangiopathic hemolysis. Bone marrow examination revealed an increased number of megakaryocytes. We diagnosed the case as TMA and initiated plasma exchange, I.V. pulse steroid treatment and stopped everolimus. This approach improved laboratory and clinic abnormalities. The development of TMA after treatment with everolimus and the exclusion of other possible causes suggested TMA associated with proliferating signal inhibitors (PSIs) in our case.

show abstract

Section: Discussionsupporting

confidence: 51%

Thrombotic thrombocytopenic purpura associated with everolimus use in a renal transplant patient

et al. 2010

View full text Add to dashboard Cite

show abstract

“…TMA of retinal vessels may be more common than is expected from the literature. Coagulopathy in COVID-19 has been widely reported ( 17 , 18 ). Jhaveri et al reported the first case of systemic TMA in a COVID-19 patient and demonstrated widespread microthrombi and diffuse cortical necrosis in kidney biopsy ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

Retinal Involvement in COVID-19: Results From a Prospective Retina Screening Program in the Acute and Convalescent Phase

et al. 2021

View full text Add to dashboard Cite

Objective: To detect retinal involvement in coronavirus disease 2019 (COVID-19) patients in acute and convalescent phase by their fundus screening.Methods: In a prospective, cross-sectional, observational study (July–November 2020), 235 patients (142 acute and 93 convalescent phase) underwent fundus screening in a tertiary care center in North India. For convalescent phase, “hospitalized” patients (73) were screened at least 2 weeks after hospital discharge, and “home-isolated” patients (20) were screened 17 days after symptom onset/COVID-19 testing.Results: None in acute phase showed any retinal lesion that could be attributed exclusively to COVID-19. Five patients (5.38%) in convalescent phase had cotton wool spots (CWSs) with/without retinal hemorrhage, with no other retinal finding, and no visual symptoms, seen at a median of 30 days from COVID-19 diagnosis.Conclusions: CWSs (and retinal hemorrhages) were an incidental finding in COVID-19, detected only in the convalescent phase. These patients were much older (median age = 69 years) than the average age of our sample and had systemic comorbidities (diabetes mellitus, hypertension, etc.). We propose the term “COVID-19 retinopathy” to denote the presence of CWSs at the posterior pole, occasionally associated with intraretinal hemorrhages, in the absence of ocular inflammation in patients with a history of COVID-19 disease.

show abstract

“…Ocular toxicity can manifest as cotton-wool spots and hemorrhage, with 1 reported case describing an extreme case of a Purtscher-like retinopathy. 333,334 In addition, central retinal vein occlusion has been reported with use following transplant. 335 Optic neuropathy has been seen in rare cases.…”

Section: Diagnostic Testingmentioning

confidence: 99%

“…Treatment options include starting intravenous corticosteroid therapy with or without plasmapheresis or medication cessation if feasible. 333,334…”

Section: Managementmentioning

confidence: 99%

The Impact of Systemic Medications on Retinal Function

Somisetty

Santina

Sarraf

et al. 2023

Asia-Pacific Journal of Ophthalmology

View full text Add to dashboard Cite

This study will provide a thorough review of systemic (and select intravitreal) medications, along with illicit drugs that are capable of causing various patterns of retinal toxicity. The diagnosis is established by taking a thorough medication and drug history, and then by pattern recognition of the clinical retinal changes and multimodal imaging features. Examples of all of these types of toxicity will be thoroughly reviewed, including agents that cause retinal pigment epithelial disruption (hydroxychloroquine, thioridazine, pentosan polysulfate sodium, dideoxyinosine), retinal vascular occlusion (quinine, oral contraceptives), cystoid macular edema/retinal edema (nicotinic acid, sulfa-containing medications, taxels, glitazones), crystalline deposition (tamoxifen, canthaxanthin, methoxyflurane), uveitis, miscellaneous, and subjective visual symptoms (digoxin, sildenafil). The impact of newer chemotherapeutics and immunotherapeutics (tyrosine kinase inhibitor, mitogen-activated protein kinase kinase, checkpoint, anaplastic lymphoma kinase, extracellular signal-regulated kinase inhibitors, and others), will also be thoroughly reviewed. The mechanism of action will be explored in detail when known. When applicable, preventive measures will be discussed, and treatment will be reviewed. Illicit drugs (cannabinoids, cocaine, heroin, methamphetamine, alkyl nitrite), will also be reviewed in terms of the potential impact on retinal function.

show abstract

Retinal Injury as an Early Manifestation of Posttransplant Thrombotic Microangiopathy: Recovery With Plasma Exchanges and Conversion to Sirolimus—Case Report and Review of the Literature

Cited by 6 publications

References 25 publications

Thrombotic thrombocytopenic purpura associated with everolimus use in a renal transplant patient

Thrombotic thrombocytopenic purpura associated with everolimus use in a renal transplant patient

Retinal Involvement in COVID-19: Results From a Prospective Retina Screening Program in the Acute and Convalescent Phase

The Impact of Systemic Medications on Retinal Function

Contact Info

Product

Resources

About