Abstract
A 34-year-old Caucasian female presented with headache, fatigue, mild abdominal pain, and dehydration. She admitted to intravenous abuse of 'melted' Opana ER tablets (extended-release oral formulation of oxymorphone hydrochloride). Noted clinical signs included tachycardia, tachypnea, and trace peripheral edema. Abnormal laboratory tests included low creatinine clearance, hemoglobin, hematocrit, and platelet. Histological studies of hepatorenal biopsies showed evidence of severe active thrombotic microangiopathy (TMA) involving the arterioles and small arteries of the kidney and scattered portal and lobular granulomata and hepatic vascular changes involving the hepatic artery branches in some portal tract. To our knowledge of the published English literature, this is probably the first case report of Opana induced thrombotic microangiopathy (TMA) with evidence of histological involvement to both the kidney and the liver.
Highlights
Long-acting opioids formulations have been used for treatment of moderate to severe chronic pain
Opana ER, a selective μ-opioid agonist made by Endo Pharmaceuticals, is an oral extended-release formulation of oxymorphone hydrochloride originally approved by US Food and Drug Administration (FDA) in 2006 for the treatment of chronic pain [1]
The first cases of thrombotic thrombocytopenic purpura (TTP) - mimicking illness associated with intravenous abuse of Opana ER were reported in 2012 in Tennessee, U.S.A. [2]
Summary
Long-acting opioids formulations have been used for treatment of moderate to severe chronic pain. Opana ER, a selective μ-opioid agonist made by Endo Pharmaceuticals, is an oral extended-release formulation of oxymorphone hydrochloride originally approved by US Food and Drug Administration (FDA) in 2006 for the treatment of chronic pain [1]. The first cases of thrombotic thrombocytopenic purpura (TTP) - mimicking illness associated with intravenous abuse of Opana ER were reported in 2012 in Tennessee, U.S.A. Despite warnings by FDA and CDC and release of a crush-resistant formulation of Opana by the drug maker, patients were still able to melt the tablets for intravenous abuse [3,4,5,6,7,8]. We report the first case of Opana induced thrombotic microangiopathy (TMA) involving both the kidney and the liver
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