QUININE-INDUCED HEMOLYTIC-UREMIC SYNDROME

Although quinine use is very common, hemolytic uremic syndrome (HUS) f ollowing exposure to quinine is only a recently reported phenomenon, w ith the first description published in 1991. Previous reports have con centrated on the nature of the hematological process and in particular characterization of the quinine-induced antibodies involved. We prese nt a case of HUS with a clear temporal and immunological relationship to quinine which demonstrates the pathognomonic renal features of HUS. An indirect antiglobulin test with the patient's serum agglutinated r ed blood cells only in the presence of quinine. Renal biopsy features included glomerular and arteriolar endothelial swelling, capillary loo p thrombi, mesangiolysis, segmental sclerosis and segmental ischemia. Early empiric treatment with plasma exchange and corticosteroids was i nstituted and this resulted in recovery of renal function to normal.