Abstract: SA-PO0730
A Pill with Unexpected Consequences: Drug-Induced Thrombotic Microangiopathy with a Single Nonsteroidal Anti-Inflammatory Drug (NSAID) Dose
Session Information
- Glomerular Diseases: Complement-Mediated Glomerulopathies and Infection-Related GN
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Marten, Juan C., Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic
- Rojas, Limber Ivan, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic
- Guzman, Elin V., Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic
Introduction
Adverse drug reactions are a potential cause of thrombotic microangiopathy (TMA), clinically characterized by microangiopathic hemolytic anemia and thrombocytopenia. In some patients with drug-induced TMA (DITMA), renal injury is severe, and these patients are often described as having Hemolytic Uremic Syndrome (HUS) or Thrombotic Thrombocytopenic Purpura (TTP).
Case Description
This is a 26-year-old female patient with a history of endometriosis treated surgically 5 months prior. Following the procedure, she underwent 3 months of treatment with nortestosterone and is currently being treated with clomiphene to induce ovulation. Forty-eight hours later, she experienced dysmenorrhea and self-medicated with single dose diclofenac. Subsequently, the patient awoke with palpitations, unmeasured fever, diffuse sharp abdominal pain, and nausea leading to vomiting. Upon admission continued with oliguria, thrombocytopenia, elevated liver enzymes, no sonographic changes and negative results for viruses and cultures. Hemodialysis support was initiated. Patient persisted with anemia, thrombocytopenia and hypertension. After intravenous steroid pulses and multiple hemodialysis sessions, a percutaneous renal biopsy was performed reporting Thrombotic Microangiopathy (TMA) and Acute Interstitial Nephritis. She is currently in complete remission of her kidney disease and under follow-up appointments.
Discussion
This case is presented to highlight its difficult management, given the rapid clinical deterioration and the lack of awareness regarding the possibility of a single dose of NSAIDs causing this type of pathology, which limited the initiation of targeted therapy. However, the evidence of progressive constitutional syndrome, thrombocytopenia, and findings of microangiopathic hemolytic anemia points to the possibility of atypical thrombotic microangiopathy
LM with congested glomeruli in an area of hemorrhage, with attenuation of the mesangium and capillary walls.