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Abstract
Atypical haemolytic uraemic syndrome, (aHUS) is a rare but potentially lifethreatening condition with clinical manifestations of haemolytic anaemia, thrombocytopenia, and renal failure. We report the first case of aHUS secondary to cabazitaxel in the setting of metastatic castrate resistant prostate cancer. In July 2015, a 73 year old male presented with acute on chronic back pain, in the context of metastatic castrate-resistant prostate cancer with known pulmonary and skeletal metastases. He was day 3 into his first cycle of cabazitaxel. Within 24 hours of admission, he acutely deteriorated with progressive drowsiness and the development of an acute kidney injury. During this period, he developed acute thrombocytopenia, falling to 58 x 109/L and haemolytic anaemia. He had a coagulopathy, with an elevated INR 1.5, but with a normal APTT and fibrinogen levels. He was subsequently diagnosed with an atypical haemolytic uraemic syndrome. In light of his rapid decline and poor prognosis he was managed with conservative treatment. Over the next 24 hours, he developed progressive acute renal failure and ongoing haemolysis. There was further neurological deterioration which culminated in his passing away three days following his initial presentation. With the
Highlights
Atypical haemolytic uraemic syndrome is an uncommon, but potentially life threatening disease with a high mortality rate [1]. It is typically characterised by complement dysfunction leading to thrombocytopaenia, haemolytic anaemia and acute renal failure
We present the first case of cabazitaxel related Atypical haemolytic uraemic syndrome (aHUS) with a review of the literature surrounding aHUS and its association with chemotherapy and prostate cancer
HUS is a disease entity on the spectrum of microangiopathic haemolytic anaemia. It is characterised by anaemia, thrombocytopaenia and acute renal failure
Summary
Atypical haemolytic uraemic syndrome (aHUS) is an uncommon, but potentially life threatening disease with a high mortality rate [1]. On the 16th July 2015, a 73 year old male presented with acute on chronic back pain, in the context of metastatic castrate-resistant prostate cancer with known pulmonary and skeletal metastases His MRI whole spine, performed on the day of presentation revealed the source of pain to be secondary to progressive skeletal metastases at the level of L3 and was planned for palliative radiation. He did not respond to enzalutamide with further disease progression after three cycles and subsequently developed haemoptysis He was given a single fraction of radiation to his right pulmonary hilar region to control his haemoptysis and started on his third line of systemic therapy with cabazitaxel at 25mg/m2. There was further neurological deterioration on the same day which culminated in his passing away
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