Cocaine Intoxication: A Rare Cause of Thrombotic Microangiopathy

Abstract

Cocaine abuse and intoxication is a global problem leading to many medical complications that can result in significant morbidity and mortality. Many lesions, including thrombotic microangiopathy, can cause acute renal injury associated with cocaine use. We report the case of a patient who developed thrombotic microangiopathy in the context of cocaine intoxication. A 40-year-old man, with a history of intermittent cocaine abuse, was transferred to the Department of Nephrology at Aristide Le Dantec University Hospital in Dakar, for the management of declining renal function in the context of acute agitation. Physical examination showed a blood pressure of 160/100 mmHg, and proteinuria and haematuria each at three crosses in a dipstick urinary test. Neurological examination found psychometric agitation without localization. Cardiac, pulmonary, abdominal, musculoskeletal and lymph node examinations were normal. Biological investigations on admission revealed: mechanical haemolyticanaemia, thrombocytopenia and serum creatinine at 3.8 mg/dl, blood urea at 182 mg/dl. The renal ultrasound showed normal kidney size but bad differentiation. Kidney biopsy was performed and showed partial collapse of the tuft in ten glomeruli, three of which contained fibrin thrombi with sub-occlusive mucoidendothelitis and fibrinoid necrosis of arterioles. The diagnosis of thrombotic microangiopathy revealed by a haemolytic and uraemic syndrome in a cocaine intoxication context was confirmed. Evolution was favourable after blood pressure control using combined amlodipine and ramipril at full dose, and the transfusion of three units of red blood cellsand fresh frozen plasma. The patient is currently being monitored as a nephrology outpatient. At his last check up, he had a good general condition and his GFR was 29 ml/min/1.73 m3.