Biopsy-proven kidney-limited thrombotic microangiopathy associated with bevacizumab and pegylated liposomal doxorubicin: a case with a biphasic clinical course.
Naoki Chigusa, Tatsuhiko Azegami, Takashin Nakayama et al.
✦ AI-curated · Sources linked
Case in brief
A 52-year-old woman with metastatic ovarian serous adenocarcinoma developed kidney-limited thrombotic microangiopathy (TMA) during treatment with bevacizumab and pegylated liposomal doxorubicin (PLD). She presented with progressive kidney dysfunction and proteinuria. A kidney biopsy confirmed TMA, revealing characteristic findings. After stopping PLD, her kidney function improved significantly, and proteinuria resolved.
What made this case unusual
The case illustrates a biphasic clinical course of kidney-limited TMA associated with both bevacizumab and PLD, highlighting the complexity of diagnosis in the absence of systemic symptoms.
Diagnostic / clinical pearl
Clinicians should consider kidney biopsy in patients with suspected drug-induced TMA, especially when systemic symptoms are absent, to confirm diagnosis and guide management.
Why it matters
This case emphasizes the need for awareness of kidney-limited TMA in patients receiving VEGF inhibitors and PLD, which can be challenging to recognize without typical systemic manifestations.