{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T08:56:28Z","timestamp":1793350588933,"version":"4.5.0"},"reference-count":12,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,2,20]]},"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:p>We report the case of a 63-year-old male patient admitted to our emergency department for dyspnoea, peripheral oedema, severe diarrhoea and asthenia. History revealed Crohn\u2019s disease (CD) submitted to several intestinal surgical resections in the previous years. He recently started a treatment with adalimumab for the control of CD. Laboratory tests at the admission revealed severe haemolytic anaemia and thrombocytopaenia. Haptoglobin levels were low, schistocyte count was markedly increased. In the suspect of thrombotic microangiopathy, he was admitted to our internal medicine department where we urgently started plasma exchange (PEX). We observed normal ADAMTS-13 activity in absence of Shiga toxin or enterotoxic <jats:italic>Escherichia<\/jats:italic>\n                  <jats:italic>c<\/jats:italic>\n                  <jats:italic>oli<\/jats:italic> at stool tests. Despite a diagnosis of atypical haemolytic\u2013uraemic syndrome, we observed full platelet count recovery and schistocytes normalisation after the fourth PEX. We then put a diagnosis of adalimumab-induced thrombocytopaenic microangiopathy. Adalimumab was withdrawn. We did not observe relapses in the following 3\u2009months.<\/jats:p>","DOI":"10.1136\/bcr-2019-233526","type":"journal-article","created":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T04:05:12Z","timestamp":1583381112000},"page":"e233526","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Adalimumab as a potential cause of drug-induced thrombocytopaenic microangiopathy"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3411-2388","authenticated-orcid":false,"given":"Lorenzo","family":"Falsetti","sequence":"first","affiliation":[{"name":"Medicina Interna Subintensiva, Ospedali Riuniti, Ancona, Marche, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Sampaolesi","sequence":"additional","affiliation":[{"name":"Scuola di Specializzazione di Medicina d'Urgenza, Universit\u00e0 Politecnica delle Marche, Ancona, Marche, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Riccomi","sequence":"additional","affiliation":[{"name":"Scuola di Specializzazione di Medicina d'Urgenza, Universit\u00e0 Politecnica delle Marche, Ancona, Marche, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinzia","family":"Nitti","sequence":"additional","affiliation":[{"name":"Medicina Interna Subintensiva, Ospedali Riuniti, Ancona, Marche, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,3,4]]},"reference":[{"key":"2025082711052929000_13.3.e233526.1","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/j.hoc.2017.08.010","article-title":"Thrombotic microangiopathies (TTP, HUS, HELLP)","volume":"31","author":"Kappler","year":"2017","journal-title":"Hematol Oncol Clin North Am"},{"key":"2025082711052929000_13.3.e233526.2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.160142"},{"key":"2025082711052929000_13.3.e233526.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-0968.2003.00127.x"},{"key":"2025082711052929000_13.3.e233526.4","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-11-611335"},{"key":"2025082711052929000_13.3.e233526.5","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1111\/imj.12055","article-title":"Thrombotic thrombocytopenic purpura associated with adalimumab (Humira) treatment in Crohn disease","volume":"43","author":"Zbaras","year":"2013","journal-title":"Intern Med J"},{"key":"2025082711052929000_13.3.e233526.6","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s12032-018-1094-7","article-title":"The impact of anaemia, transfusion dependency, comorbidities and polypharmacy in elderly patients with low-risk myelodysplastic syndromes","volume":"35","author":"Castelli","year":"2018","journal-title":"Med Oncol"},{"key":"2025082711052929000_13.3.e233526.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2006.03146.x"},{"key":"2025082711052929000_13.3.e233526.8","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1157\/13062893","article-title":"[Idiopathic thrombocytopenic purpura as an extraintestinal manifestation of Crohn's disease]","volume":"27","author":"Mance\u00f1ido Marcos","year":"2004","journal-title":"Gastroenterol Hepatol"},{"key":"2025082711052929000_13.3.e233526.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2012.04.001"},{"key":"2025082711052929000_13.3.e233526.10","doi-asserted-by":"crossref","first-page":"244","DOI":"10.3109\/0886022X.2010.541577","article-title":"A patient with Crohn's disease who presented with thrombotic thrombocytopenic purpura\/hemolytic uremic syndrome","volume":"33","author":"Unverdi","year":"2011","journal-title":"Ren Fail"},{"key":"2025082711052929000_13.3.e233526.11","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/00004836-200301000-00027","article-title":"Autoimmune thrombotic thrombocytopenic purpura: a severe complication of inflammatory bowel disease","volume":"36","author":"Schleinitz","year":"2003","journal-title":"J Clin Gastroenterol"},{"key":"2025082711052929000_13.3.e233526.12","first-page":"327","article-title":"Differenzialdiagnose und therapie thrombotischer Mikroangiopathien","volume":"115","author":"Bommer","year":"2018","journal-title":"Dtsch. Arztebl. Int"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-233526","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:05:40Z","timestamp":1756317940000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-233526"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3]]},"references-count":12,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,3,4]]},"published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1136\/bcr-2019-233526"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-233526","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3]]}}}