{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:06:32Z","timestamp":1776722792003,"version":"3.51.2"},"reference-count":9,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,3,10]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>\n                    A young woman presented with acute right flank pain, fever and thrombocytopenia. Initial evaluation suggested pyelonephritis, supported by flank tenderness, elevated C-reactive protein, and\n                    <jats:italic>Eschericia coli<\/jats:italic>\n                    in urine culture. Broad-spectrum antibiotics were initiated. Over the following 2 days, she developed progressive anaemia and severe thrombocytopenia with biochemical evidence of haemolysis. Differential diagnoses included infection-related haemolysis, atypical haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura (TTP) and drug-induced thrombotic microangiopathy (TMA). Initial imaging was inconclusive, while follow-up CT later during admission demonstrated findings consistent with pyelonephritis, but haematological deterioration was disproportionate. ADAMTS13 enzymatic activity was normal, excluding classic TTP, and a drug screen confirmed recent cocaine use. Microscopy revealed schistocytes, consistent with TMA. The patient\u2019s condition progressed rapidly with marked anaemia and thrombocytopenia by day 3. She was transferred to a tertiary specialised centre on day 4, improved with supportive care alone and achieved full recovery on day 8. This case emphasises the importance of recognising drug-induced TMA and distinguishing it from primary forms to guide appropriate management.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2025-271584","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:35:22Z","timestamp":1774532122000},"page":"e271584","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Cocaine-induced thrombotic microangiopathy mimicking TTP in a young patient"],"prefix":"10.1136","volume":"19","author":[{"given":"Anna Katrine Nyman","family":"Rasmussen","sequence":"first","affiliation":[{"name":"Hematology, Odense University Hospital, Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nanna","family":"Reiter","sequence":"additional","affiliation":[{"name":"Intensive Care, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mads Gabriel","family":"Tiddy","sequence":"additional","affiliation":[{"name":"Nephrology, Esbjerg and Grindsted Hospital, Esbjerg, Region Syddanmark, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaj","family":"Mannering","sequence":"additional","affiliation":[{"name":"Hematology, Odense University Hospital, Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"2026032606351238000_19.3.e271584.1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-10-709857"},{"key":"2026032606351238000_19.3.e271584.2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-02-0344"},{"key":"2026032606351238000_19.3.e271584.3","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1093\/ckj\/sfx061","article-title":"The potential role of complements in cocaine-induced thrombotic microangiopathy","volume":"11","author":"Dejman","year":"2018","journal-title":"Clin Kidney J"},{"key":"2026032606351238000_19.3.e271584.4","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1002\/jca.21687","article-title":"A case off TTP temporally associated with cocaine use: Implications for treatment of suspected DITMA","volume":"34","author":"Regner","year":"2019","journal-title":"J Clin Apher"},{"key":"2026032606351238000_19.3.e271584.5","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s002770050155","article-title":"Cocaine-induced microangiopathic hemolytic anemia and thrombocytopenia simulating thrombotic thrombocytopenia purpura","volume":"72","author":"Keung","year":"1996","journal-title":"Ann Hematol"},{"key":"2026032606351238000_19.3.e271584.6","doi-asserted-by":"crossref","DOI":"10.1016\/S0272-6386(00)70321-0","article-title":"Cocaine-induced acute renal failure, hemolysis, and thrombocytopenia mimicking thrombotic thrombocytopenic purpura","volume":"35","author":"Volcy","year":"2000","journal-title":"Am J Kidney Dis"},{"key":"2026032606351238000_19.3.e271584.7","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1002\/jca.21316","article-title":"Cocaine-induced microangiopathic hemolytic anemia mimicking idiopathic thrombotic thrombocytopenic purpura: a case report and review of the literature","volume":"29","author":"Odronic","year":"2014","journal-title":"J Clin Apher"},{"key":"2026032606351238000_19.3.e271584.8","unstructured":"UpToDate . Drug-induced thrombotic microangiopathy (DITMA). n.d. Available: www.uptodate.com"},{"key":"2026032606351238000_19.3.e271584.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0902814"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271584","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T13:35:25Z","timestamp":1774532125000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271584"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":9,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,26]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bcr-2025-271584"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271584","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}