Presse Med
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Thrombotic microangiopathy (TMA) regroups the hemolytic and uremic syndrome (HUS) and thrombocytopenic thrombotic purpura (TTP). The TMA associated with cancer can be secondary to cancer, hence similar to TTP, or to chemotherapy, creating an HUS. Gemcitabine, used in the treatment of pulmonary, pancreatic and urothelial carcinomas, is generally well tolerated, but has recently been implied in the occurrence of TMA. ⋯ The incidence of TMA is of around 5 to 6% of metastatic carcinomas. Gemcitabine-induced TMA are of recent occurrence and some twelve cases have been reported. Their occurrence is delayed with regard to the initiation of gemcitabine. They lead to HUS with good prognosis since, on withdrawal of gemcitabine the renal abnormalities regress. Search for TMA should therefore be proposed after more than 10 cycles of treatment with gemcitabine.
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Ivermectine, derived from beta avermectines, monocyclic lactones produced by Streptomyces avermitilis, is a potent oral microfilaricide used by veterinaries since 1981. The anti-filarial activity is two-fold: both microfilaricide and embryotoxic in female adults; it has no activity on the latter. ⋯ Its activity has been recently extended to ectoparasitosis: sarcoptes and pediculosis of the scalp.