title: Concomitant acral necrosis and haemolytic uraemic syndrome following ingestion of quinine.
abstract: Thrombotic microangiopathy, which broadly includes thrombotic thrombocytopaenic purpura (TTP) and haemolytic uraemic syndrome (HUS), is a multisystemic disorder that is characterised by thrombocytopaenia, microangiopathic haemolytic anemia and ischaemic manifestations, resulting from platelet agglutination in the arterial microvasculature. Acral necrosis (distal necrosis of fingers and toes) occurs usually as a sequel to severe Raynaud's phenomenon, a vasculospastic disorder frequently related to endothelial cell dysfunction. We report a case of quinine induced TTP-HUS and acral necrosis, two distinct clinical abnormalities which have not yet been reported together in association with quinine. Both of these conditions in this case resolved promptly to treatment with corticosteroids.
authors.affiliation: Department of Internal Medicine, University of Iowa Hospital, Iowa City, Iowa 52242, USA. neeraj-agarwal@uiowa.edu
authors.forename: N
authors.initials: N
authors.lastname: Agarwal
authors.forename: B
authors.initials: B
authors.lastname: Cherascu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D001707:Biopsy, Needle; D005500:Follow-Up Studies; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced* / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D009336:Necrosis; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced* / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D011803:Quinine / Q000008:administration & dosage / Q000009:adverse effects*; D018570:Risk Assessment; D014034:Toes / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D011803:Quinine