title: Quinine-associated thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: frequency, clinical features, and long-term outcomes.
abstract: BACKGROUND
  Quinine-associated thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) is thought to be uncommon and to have a good prognosis.
  
  
  OBJECTIVE
  To describe the frequency, clinical features, and long-term outcomes of quinine-associated TTP-HUS.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Hospitals in central-western Oklahoma.
  
  
  METHODS
  225 consecutive patients with TTP-HUS, 1989-2000.
  
  
  METHODS
  Presenting features and clinical outcomes.
  
  
  RESULTS
  Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome was associated with quinine in 17 patients. Four patients died, and 7 survivors currently have chronic renal failure. Since 1 July 1995, 132 patients with clinically suspected TTP-HUS were explicitly asked about drug exposure. Fourteen (11%) had taken quinine, and 7 had taken other drugs associated with TTP-HUS. Neurologic abnormalities were as severe in patients with quinine-associated TTP-HUS as in the 118 patients who had not taken quinine.
  
  
  CONCLUSIONS
  Quinine is a common cause of drug-associated TTP-HUS and can cause death and chronic renal failure. When the disorder is described as TTP-HUS rather than only as HUS, the severity of neurologic abnormalities and the occasional absence of renal failure are emphasized. If recurrent disease is to be prevented, clinicians must recognize quinine as a possible cause.
authors.affiliation: Hematology-Oncology Section, Department of Medicine, University of Oklahoma Health Sciences Center, Box 26901, Oklahoma City, OK 73190, USA.
authors.forename: K
authors.initials: K
authors.lastname: Kojouri
authors.forename: S K
authors.initials: SK
authors.lastname: Vesely
authors.forename: J N
authors.initials: JN
authors.lastname: George
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D004342:Drug Hypersensitivity / Q000150:complications; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000628:therapy; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000009:adverse effects*; D018482:Muscle, Skeletal / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced* / Q000628:therapy; D011803:Quinine / Q000009:adverse effects*; D006435:Renal Dialysis; D018709:Statistics, Nonparametric
chemical_list: D009125:Muscle Relaxants, Central; D011803:Quinine