Thrombotic Microangiopathy after a 15-year Treatment with Interferon Beta-1b in a Patient with Multiple Sclerosis: A Case Report and Review of Literature
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- Akita Satori
- Department of Cardiology, Kanazawa Medical University, Japan
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- Fujibayashi Kosuke
- Department of Cardiology, Kanazawa Medical University, Japan
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- Ueno Ei-ichi
- Department of Cardiology, Kanazawa Medical University, Japan
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- Wakasa Minoru
- Department of Cardiology, Kanazawa Medical University, Japan
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- Kawai Yasuyuki
- Department of Cardiology, Kanazawa Medical University, Japan
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- Kajinami Kouji
- Department of Cardiology, Kanazawa Medical University, Japan
Abstract
<p>A 54-year-old woman with multiple sclerosis treated with interferon-β (IFN-β)-1b for 15 years presented with sustained hypertension (240/124 mmHg) and retinal bleeding. She had proteinuria, anemia, thrombocytopenia, elevated serum creatinine levels, and haptoglobin depletion. Intravenous nicardipine stabilized her blood pressure, but her renal function and platelet count deteriorated. The initial disintegrin-like metalloprotease with thrombospondin type 1 motifs 13 (ADAMTS13) activity was 28% of normal without its inhibitor. The subsequent peripheral appearance of schistocytes suggested thrombotic microangiopathy (TMA). After IFN-β-1b cessation, the platelet count increased, and the blood pressure stabilized. The ADAMTS13 activity normalized, although the creatinine level did not. TMA may develop after the long-term use of IFN-β without adverse events. </p>
Journal
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- Internal Medicine
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Internal Medicine 63 (8), 1113-1117, 2024-04-15
The Japanese Society of Internal Medicine