Delayed and sequencial hemolytic uremic syndrome as a complication of Gemcitabine therapy

Abstract

Gemcitabine is a widely used drug in the treatment of diverse malignancies and its use has been approved by the US Food and Drug Administration. This drug has been associated with a rare adverse event, the Hemolytic Uremic Syndrome (HUS), characterized by acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia. The purpose of this report is to draw attention to an atypical manifestation of this severe and unusual complication, and discuss its management and outcome. We report a 70-year-old woman with Li-Fraumeni syndrome diagnosed with pancreatic adenocarcinoma and leiomyosarcoma, whom after fourteen cycles of therapy with gemcitabine and nab-paclitaxel, with good disease control, developed clinical manifestation of atypical HUS with exuberant pulmonary symptoms, followed by hemolytic anemia, and acute renal failure presenting on an unusual sequential fashion. The case highlights the importance of maintaining a high suspicion for SHU in patients receiving gemcitabine,being aware that delayed and atypical manifestations may occur.

Keywords

• pancreatic neoplasms
• hemolytic-uremic syndrome
• drug therapy