Quinine Sensitivity: A New Cause of the Hemolytic Uremic Syndrome
Authors: Richard H. Aster
Journal: Annals of Internal Medicine (1993)

Editorials1 August 1993Quinine Sensitivity: A New Cause of the Hemolytic Uremic SyndromeRichard H. Aster, MDRichard H. Aster, MDMedical College of Wisconsin, Milwaukee, WI 53233.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-3-199308010-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue of Annals, Maguire and coworkers [1] describe two patients who had symptoms and laboratory findings consistent with the adult hemolytic uremic syndrome of acute onset. In addition to the expected findings of microangiopathic hemolytic anemia, thrombocytopenia, and renal failure, both patients had neutropenia and low-grade disseminated intravascular coagulation. One patient had a similar episode about 2 years earlier, and the other reported many previous episodes. The initial histories that the patients gave failed to identify exposure to medications. However, the urine of one patient contained quinine, the probable source of which was tonic water, and circumstantial evidence ...References1. Maguire RB, Stroncek DF, Campbell AC. Recurrent pancytopenia, coagulopathy, and renal failure associated with multiple quinine-dependent antibodies. Ann Intern Med. 1993; 119:215-7. Google Scholar2. Gottschall JL, Elliot W, Lianos E, McFarland JG, Wolfmeyer K, Aster RH. Quinine-induced immune thrombocytopenia associated with hemolytic uremic syndrome: a new clinical entity. Blood. 1991; 77:306-10. Google Scholar3. Spearing RL, Hickton CM, Sizeland P, Hannah A, Bailey RR. Quinine-induced disseminated intravascular coagulation. Lancet. 1990; 336:1535-7. Google Scholar4. Stroncek DF, Vercellotti GM, Hammerschmidt DE, Christie DJ, Shankar RA, Jacob JS. Characterization of multiple quinine-dependent antibodies in a patient with episodic hemolytic uremic syndrome and immune agranulocytosis. Blood. 1992; 80:241-8. Google Scholar5. 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Google Scholar11. Chong BH. Drug-induced immune thrombocytopenia. Platelets. 1991; 2:173-81. Google Scholar12. Neahring BJ, Scott JP, Visentin GP, Gottschall JL, Aster RH. Quinine-dependent anti-endothelial cell antibodies in plasma of patients with hemolytic-uremic syndrome (HUS). Proceeding of the 14th Congress of International Society of Thrombosis and Hemostasis. 1993; (In press). Google Scholar13. Jones K, Castleden CM. A double-blind comparison of quinine sulphate and placebo in muscle cramps. Age Ageing. 1983; 12:155-8. Google Scholar14. Fung MC, Holbrook JH. Placebo-controlled trial of quinine therapy for nocturnal leg cramps. Western J Med. 1989; 151:42-4. Google Scholar15. Gorlich HD, Gablenz EV, Steinberg HW. Behandlung rezidivierender nachtlicher Wadenkrampfe. Eine multizentrische, doppelblinde, plazebo-kontrollierte vergleichsuntersuchung zwischen der kombination von chinin und theophyllin-ethylendiamin gegenuber chinin. Drug Res. 1991; 41:167-75. Google Scholar16. Connolly PS, Shirley EA, Wasson JH, Nierenberg DW. Treatment of nocturnal leg cramps. A crossover trial of quinine vs vitamin E. Arch Intern Med. 1992; 152:1877-80. Google Scholar Author, Article, and Disclosure InformationAuthors: Richard H. Aster, MDAffiliations: Medical College of Wisconsin, Milwaukee, WI 53233.Corresponding Author: Richard H. Aster, MD, The Blood Center, 1701 West Wisconsin Avenue, Milwaukee, WI 53233.Grant Support: By grant HL13621 from the National Heart, Lung, and Blood Institute. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRecurrent Pancytopenia, Coagulopathy, and Renal Failure Associated with Multiple Quinine-dependent Antibodies Robert B. Maguire , David F. Stroncek , and Allan C. Campbell Metrics Cited byQuinine-Induced Thrombotic Microangiopathy: A Report of 19 PatientsRenal Involvement in Children with HUSRenal Involvement in Children with HUSAtypical Hemolytic Uremic SyndromeThrombotic microangiopathic syndromes associated with drugs, HIV infection, hematopoietic stem cell transplantation and cancerAlkaloids in the human food chain - Natural occurrence and possible adverse effectsHHow I treat patients with thrombotic thrombocytopenic purpura: 2010Fluoroquinolone-induced immune thrombocytopenia: a report and reviewHemolytic Uremic SyndromeA classification of hemolytic uremic syndrome and thrombotic thrombocytopenic purpura and related disordersImmune Hemolysis Associated with TransplantationQuinine Induced HUS-TTP: An Unusual PresentationQuinine‐induced disseminated intravascular coagulation and haemolytic–uraemic syndromeApheresis for Renal DiseaseThe lady who had muscle cramps and developed thrombotic microangiopathyShould People with Nocturnal Leg Cramps Drink Tonic Water and Bitter Lemon?Therapeutic Apheresis for Renal DisordersSHOULD PEOPLE WITH NOCTURNAL LEG CRAMPS DRINK TONIC WATER AND BITTER LEMON?Quinine Hypersensitivity Simulating SepsisPlasma Exchange in Renal Disease 1 August 1993Volume 119, Issue 3Page: 243-244KeywordsAntibodiesBlood cellsDisseminated intravascular coagulationDrugsGlycoproteinsGranulocytesHemolytic-uremic syndromePlateletsQuinineUrine ePublished: 15 August 2000 Issue Published: 1 August 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. 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