Nathaniel J. Myall, MDa; Samantha X. Wang, MDa; Evan T. Hall, MDb; Wesley H. Witteles, MDa,c; Lawrence Leung, MDa,c;Tamara J. Dunn, MDa,c; and Wan-Jen Hong, MDa,c Correspondence: Wan-Jen Hong (wanjen@stanford.edu)
aStanford University, California bUniversity of Washington, Seattle cVeterans Affairs Palo Alto Health Care System, California
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
Ethics and consent
Consent for publication was obtained from the patients described in the case report.
DITMA is a known risk of proteasome inhibitors and is listed as a safety warning in the prescribing information for bortezomib, carfilzomib, and ixazomib.12 Given the overall rarity of this adverse event, the simultaneous presentation of our 2 cases was unexpected and underscores the need for heightened awareness in clinical practice. In addition, while no underlying complement mutations were identified, eculizumab was used in both cases to successfully stabilize renal function. Further research investigating the efficacy of eculizumab and the role of complement activation in proteasome inhibitor–induced TMA will be valuable.
Acknowledgments
The authors would like to thank the patients whose histories are reported in this manuscript as well as the physicians and staff who provided care during the hospitalizations and beyond. We also thank Oscar Silva, MD, PhD, for his assistance in reviewing and formatting the peripheral blood smear images.
