Transplant-associated Thrombotic Microangiopathy: An Enigma Treated with Eculizumab

A BSTRACT Transplant-associated thrombotic microangiopathy (TA-TMA) is characterized by high mortality and morbidity, often presenting with TMA and renal dysfunction. The condition can be challenging to diagnose due to overlapping symptoms with other HSCT complications. Here, we discuss the medical history of a young patient with acute myeloid leukemia who underwent hematopoietic stem cell transplantation (HSCT). The patient’s posttransplant course was complicated by several issues, including liver graft-versus-host disease, neutropenic sepsis, and suspected calcineurin inhibitor toxicity, which led to the discontinuation of tacrolimus. This case of TA-TMA post-HSCT shows the complexity of this condition. The interventions, including plasmapheresis, dialysis, and eculizumab, were pivotal in stabilizing her condition. The renal biopsy which was done once her active disease settles confirmed the clinical suspicion. It is encouraging to see that she no longer requires dialysis, and her hematological parameters have normalized.