Drug-induced thrombotic microangiopathy associated with eltrombopag

Drug-induced thrombotic microangiopathy due to an immune reaction is idiosyncratic and not dose-dependent. The classic example is quinine-dependent antibodies resulting in thrombotic microangiopathy due to activation of endothelial cells. Eltrombopag is a thrombopoietin-receptor agonist indicated in resistant chronic immune thrombocytopenia (ITP). This is the first report of full-blown biopsy-proven thrombotic microangiopathy with acute kidney injury (AKI) and nephrotic syndrome (NS) in a patient with chronic ITP who was initiated on eltrombopag therapy.