Thrombotic microangiopathy involving kidney allograft and peripheral nerves.
Elie NaddafP James B DyckSamar SaidHatem AmerPublished in: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (2019)
While thrombotic microangiopathy (TMA) can commonly affect the kidney, peripheral nerve involvement has not been reported to date. A 56-year-old man, recipient of a kidney allograft, reported severe headaches, tremors, and diarrhea followed by sudden-onset right foot drop after increasing his dose of tacrolimus. He then developed acute right hand pain, numbness, and weakness. At presentation, neurological examination and electroneuromyography confirmed the presence of right worse than left, sciatic and ulnar mononeuropathies. Kidney biopsy showed evidence of a thrombotic microangiopathy. Similarly, nerve biopsy showed thrombosis of epineurial blood vessels with minimal inflammation. Herein, we demonstrated that thrombotic microangiopathy can involve the peripheral nerves, resulting in major morbidity. Distinguishing TMA from vasculitis is important because it has major treatment implications.
Keyphrases
- peripheral nerve
- oxidative stress
- neuropathic pain
- liver failure
- ultrasound guided
- pulmonary embolism
- fine needle aspiration
- drug induced
- kidney transplantation
- early onset
- intensive care unit
- chemotherapy induced
- combination therapy
- brain injury
- clostridium difficile
- subarachnoid hemorrhage
- replacement therapy
- mechanical ventilation