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Intravenous OxyContin-associated thrombotic microangiopathy treated successfully without plasma exchange

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In April 2014, in response to intravenous misuse of oral extended-release oxycodone hydrochloride, a new tamper-resistant formulation was released in Australia. We report a case of thrombotic microangiopathy after intravenous misuse of the new tamper-resistant formulation that was successfully managed without plasma exchange.

Clinical record

A 56-year-old man of European ancestry with no clinically significant medical history presented with a 3-day history of periumbilical abdominal pain. He admitted to daily intravenous (IV) misuse of oral extended-release oxycodone hydrochloride (OxyContin; Mundipharma) over a period of months. For the 5 weeks before presentation, he had been injecting the new tamper-resistant formulation because he was unable to access the discontinued crushable form.

On presentation, the patient was afebrile, had a pulse of 95 beats/min, blood pressure of 154/85 mmHg, a respiratory rate of 14 breaths/min and oxygen saturation of 97%. On examination, he had mild periumbilical tenderness. Results of cardiovascular and respiratory examinations were unremarkable. No murmur was detected. There was no injection site infection or axillary lymphadenopathy.

Laboratory investigations showed a haemoglobin level of 87 g/L (reference interval [RI], 135–180 g/L), a total white cell count of 15.0 × 109/L (RI, 4–11 × 10

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