Case had features of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome

EDITOR—Tweddle et al's drug point described neurotoxicity due to cyclosporin after chemotherapy for lymphoproliferative disease after cardiac transplantation; the authors commented that it had not been reported in this setting previously.1 The article failed to mention thrombotic microangiopathy, which it is essential to consider in such patients.

Thrombotic thrombocytopenic purpura and the haemolytic uraemic syndrome are closely related conditions; they are associated with fever, thrombocytopenia, red cell fragmentation, and thrombotic lesions in various organs and result in neurotoxicity and renal impairment. The aetiology of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome is poorly understood, but it has been well described after treatment with immunosuppressive drugs including cyclosporin, chemotherapy, cancer, and bone marrow transplantation.2^–5

The case described had features of thrombotic thrombocytopenic purpura and the haemolytic uraemic syndromenamely, neurotoxicity, fever, and renal impairment with hypertension. No comment is made on the patient's …