Critical Care Medicine-Hematologic and Oncologic Disorders>>>>>Complications of Immunosuppressive Drugs and Chemotherapy
Question 3#

A 52-year-old woman with a history of depression, diabetes, and hypertension, and who has had kidney transplantation 1.5 years ago, presents to the ED with confusion. Laboratory test results (with recent baseline) are notable for:

Which of the following medications is the most likely culprit?

A. Amlodipine
B. Lexapro
C. Metoprolol
D. Insulin
E. Sirolimus

Correct Answer is E


Correct Answer: E

This patient is presenting with evidence of a thrombotic microangiopathy, most likely hemolytic uremic syndrome (HUS). HUS following organ transplantation is commonly due to calcineurin inhibitors (cyclosporine, tacrolimus) and/or mTOR inhibitors (sirolimus, everolimus).


  1. Langer RM, Van Buren CT, Katz SM, Kahan BD. De novo hemolytic uremic syndrome after kidney transplantation in patients treated with cyclosporine a sirolimus combination. Transplant Proc. 2001;33:3236- 3237.