[Fatal untoward effect of furosemide: immunocytopenic purpura and cerebral hemorrhage].
A 74 year old man was admitted to the hospital for purpura. The history revealed coronary heart disease. Bypass surgery had been performed 18 months ago. Furosemide had recently been prescribed for cardiac insufficiency and the patient had taken the drug intermittently over two weeks. Laboratory analysis showed severe thrombocytopenia. Despite immediate treatment with intravenous prednisolone and platelet transfusions the patient succumbed to cerebral hemorrhage. Autopsy confirmed a diffuse hemorrhagic diathesis and a cellular response of the bone marrow typical for an acute immune reaction. The start of the purpura nine to ten days after the first dose of furosemide, the exclusion of other possible causes for purpura and the focal proliferation of T-lymphocytes in the bone marrow render it highly probable, that furosemide was responsible for the fatal thrombocytopenia. Furosemide is discussed to have a potential for autoimmunological untoward effects due to its sulfonamide structure. Few case reports describe vasculitic and allergic phenomena. The generation of antibodies against thrombocytes and the depression of megakaryocytic function are thought to be involved. Our patient had been treated with furosemide during the bypass surgery 18 months before the development of purpura. A sensitization to furosemide probably took place at that time.
Abteilung für Endokrinologie und Diabetologie, Inselspital Bern.
B
B
Chappuis
C
C
Cottier
D000368:Aged; D001344:Autopsy; D001853:Bone Marrow / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D017809:Fatal Outcome; D005665:Furosemide / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D006333:Heart Failure / Q000188:drug therapy; D006474:Hemorrhagic Disorders / Q000139:chemically induced; D006801:Humans; D008297:Male; D011696:Purpura, Thrombocytopenic / Q000139:chemically induced* / Q000276:immunology / Q000401:mortality / Q000473:pathology; D013997:Time Factors
D004232:Diuretics; D005665:Furosemide