• Amibhen Gandhi Temple University / Conemaugh Memorial Medical Center
  • Saad Ullah Temple University / Conemaugh Memorial Medical Center
  • Shani Kotadia Temple University / Conemaugh Memorial Medical Center
  • Samer Nasser Temple University / Conemaugh Memorial Medical Center


Background: Atypical Haemolytic Uremic Syndrome (aHUS) is a rare life threatening entity characterized by thrombocytopenia, haemolytic anaemia and renal dysfunction. It is a thrombotic microangiopathy related to genetic mutations in the alternate complement pathway and has a distinct pathophysiology which makes it harder to distinguish from other microangiopathies. We present a case of a 25-year-old male patient with history of polysubstance abuse who presented with chest pain and dyspnoea. He admitted to using injectable oxymorphone (Opana) two weeks before presentation. Patient’s vital signs were stable except for tachycardia and high blood pressure. On physical examination, epigastric tenderness and mild splenomegaly was appreciated. Urine Drug Screen was positive for oxycodone and opiates. Laboratory work up revealed haemolytic anaemia, thrombocytopenia and acute kidney injury. Extensive evaluation resulted in our impression of the disease being atypical haemolytic-uremic syndrome. He was managed with dialysis, intravenous steroids and plasmapheresis with improvement in his hematologic parameters. Keywords: Acute renal failure; atypical Haemolytic uremic syndrome; Opana; oxymorphone use; endothelial dysfunction; drug abuse 


Nester CM, Thomas CP. Atypical hemolytic uremic syn-drome: what is it, how is it diagnosed, and how is it treated? Hematology Am Soc Hematol Educ Program 2012;2012(1):617–25.

Moake JL. Thrombotic microangiopathies. N Engl J Med 2002;347(8):589–600.

Sellier-Leclerc AL, Fremeaux-Bacchi V, Dragon-Durey MA, Macher MA, Niaudet P, Guest G, et al. Differential impact of complement mutations on clinical characteristics in atypical hemolytic uremic syndrome. J Am Soc Nephrol 2007;18(8):2392–400.

Noris M, Remuzzi G. Atypical hemolytic-uremic syndrome. N Engl J Med 2009;361(17):1676–87.

Sawai T, Nangaku M, Ashida A, Fuijimaru R, Hataya H, Haidaka Y, et al. Diagnostic criteria for atypical hemolytic uremic syndrome proposed by the Joint Committee of the Japanese Society of Nephrology and the Japan Pediatric So-ciety. Clin Exp Nephrol 2014;18(1):4–9.

Proesmans W. Typical and atypical hemolytic uremic syn-drome. Kidney Blood Press Res 1996;19(3–4):205–8.

Noris M, Remuzzi G. Atypical hemolytic-uremic syndrome. N Engl J Med. 2009;361(17):1676–87.

Rane M, Aggarwal A, Banas E, Sharma A. Resurgence of intravenous Opana as a cause of secondary thrombotic thrombocytopenic purpura. Am J Emerg Med 2014;32(8):951.

Centers for Disease Control and Prevention (CDC). Throm-botic thrombocytopenic purpura (TTP)-like illness associated with intravenous Opana ER abuse – Tennessee, 2012. MMWR Morb Mortal Wkly Rep 2013;62(1):1–4.

Ambruzs JM, Serrell PB, Rahim N, Larsen CP. Thrombotic microangiopathy and acute kidney injury associated with in-travenous abuse of an oral extended-release formulation of oxymorphone hydrochloride: kidney biopsy findings and re-port of 3 cases. Am J Kidney Dis 2014;63(6):1022–6.

Miller PJ, Farland AM, Knovich MA, Batt KM, Owen J. Suc-cessful treatment of intravenously abused oral Opana ER-induced thrombotic microangiopathy without plasma ex-change. Am J Hematol 2014;89(7):695–7.

Rafiq A, Tariq H, Abbas N, Shenoy R. Atypical Hemolytic-Uremic syndrome: A Case Report and literature Review. Am J Case Rep 2015;16:109–14.

Tate C, Mollee P. Intravenous OxyContin-associated throm-botic microangiopathy treated successfully without plasma exchange. Med J Aust 2015;202(6):330–1.