title: Successful treatment of intravenously abused oral Opana ER-induced thrombotic microangiopathy without plasma exchange.
abstract: In January 2013, the Centers for Disease Control and Prevention reported an illness associated with intravenous (IV) abuse of oral Opana ER (oxymorphone) in Tennessee. The clinical presentation of this syndrome was reported to resemble that of thrombotic thrombocytopenic purpura in the 15 patients reported; 12 were treated with plasma exchange. We report a similar case series of 15 patients with 18 episodes of thrombotic microangiopathy associated with recent IV abuse of oral Opana ER. In our series, we demonstrate that therapeutic plasma exchange is unnecessary; supportive care and treatment of underlying infections and renal dysfunction (without use of plasma exchange) resulted in clinical improvement in all patients. Thus, it appears that plasma exchange with associated costs and risks can be safely omitted in patients with thrombotic microangiopathy resulting from IV abuse of oral Opana ER.
authors.affiliation: Department of Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Peter John
authors.initials: PJ
authors.lastname: Miller
authors.forename: Andrew Matthew
authors.initials: AM
authors.lastname: Farland
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Knovich
authors.forename: Katharine Marie
authors.initials: KM
authors.lastname: Batt
authors.forename: John
authors.initials: J
authors.lastname: Owen
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010111:Oxymorphone / Q000008:administration & dosage / Q000506:poisoning*; D010951:Plasma Exchange / Q000379:methods*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D015819:Substance Abuse, Intravenous / Q000097:blood / Q000209:etiology / Q000628:therapy; D057049:Thrombotic Microangiopathies / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010111:Oxymorphone