Elevated reticulocyte count - a clue to the diagnosis of haemolytic-uraemic syndrome (HUS) associated with gemcitabine therapy for metastatic duodenal papillary carcinoma: a case report

In adults, the haemolytic-uraemic syndrome (HUS) is associated with probabl e causative factors in the minority of all cases. Cytotoxic drugs are one o f these potential causative agents. Although metastatic cancer by itself is a recognized risk-factor for the development of HUS, therapy with mitomyci n-C, with cis-platinum, and with bleomycin carries a significant, albeit ex tremely small, risk for the development of HUS, compared with all other cyt otoxic drugs. Gemcitabine is a novel cytotoxic drug with promising activity against pancreatic adenocarcinoma. We are reporting on one patient with me tastatic duodenal papillary carcinoma developing HUS while on weekly gemcit abine therapy. The presenting features in this patient were non-cardiac pul monary oedema, renal failure, thrombocytopenia and haemolytic anaemia. The diagnosis of HUS was made on the day of admission of the patient to this in stitution. Upon aggressive therapy, including one single haemodialysis and five plasmaphereses, the patient recovered uneventfully, with modestly elev ated creatinine-values as a remnant of the acute illness. Re-exposure to ge mcitabine 6 months after the episode of HUS instituted for progressive carc inoma, thus far has not caused another episode of HUS.