Diagnostisch dilemma : trombotische microangiopathie tijdens de behandeling voor acute lymfatische leukemie

A 38 year-old patient with T-cell acute lymphatic leukemia (T-ALL) for which she was treated with chemotherapy according to the HOVON 100A schedule, presented with fever and edema of the eye lids. During the hospitalization thrombotic micro-angiopathy (TMA) developed, which was attributed to either secondary TMA or atypical hemolytic uremic syndrome (aHUS). Treatment with plasma therapy was started, but because of insufficient clinical improvement after five days of plasma therapy treatment with the complement inhibitor eculizumab was started, to which she responded well. This case illustrates the complex differential diagnosis in patients presenting with TMA and the complicated considerations for selecting the appropriate treatment.