QUININE-INDUCED IMMUNE THROMBOCYTOPENIA WITH HEMOLYTIC-UREMIC SYNDROME - CLINICAL AND SEROLOGICAL FINDINGS IN 9 PATIENTS AND REVIEW OF LITERATURE

Quinine-induced immune thrombocytopenia with hemolytic uremic syndrome (HUS) is a recently defined clinical entity, In this paper we have at tempted to characterize the natural history and laboratory abnormaliti es typical of quinine-induced immune thrombocytopenia associated with hemolytic uremic syndrome in nine patients experiencing ten episodes o f the disease. In addition, review of other reported cases of probable quinine-induced HUS is presented, The disease was characterized by th e onset of chills, diapheresis, nausea and vomiting, abdominal pain, d ecreased urine output, and petechiae following quinine exposure. All p atients experience significant anemia, severe thrombocytopenia, increa sed lactate dehydrogenase, elevated serum creatinine, and oliguria, Qu inine-dependent platelet-reactive antibodies were identified in eight of nine using flow cytometry. unexpectedly, drug-dependent antibodies reactive with red cells and granulocytes were identified in four and e ight patients, respectively All patients were treated with plasma exch ange (range 1-12 procedures), and seven required hemodialysis. All sur vive without residual abnormality, Our experience with nine patients w ith quinine-induced HUS and the nine additional cases reported by othe rs and reviewed in this paper establishes this condition as a distinct clinical entity, Adult patients presenting with HUS should routinely be asked about exposure to quinine in the form of medication or bevera ges, The mechanism by which quinine-dependent antibodies produce renal failure is uncertain, but preliminary studies (described elsewhere) s uggest that drug-induced antibodies reactive with endothelial cells an d possibly margination of granulocytes in renal glomeruli may be respo nsible for this complication. The prognosis in quinine-induced HUS is better than in other forms of adult HUS. (C) 1994 Wiley-Liss, Inc.