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Quinine Sensitivity: A New Cause of the Hemolytic Uremic Syndrome

Richard H. Aster, MD
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Medical College of Wisconsin, Milwaukee, WI 53233. Requests for Reprints: 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.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(3):243-244. doi:10.7326/0003-4819-119-3-199308010-00012
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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 suggested that the second patient had taken quinine to prevent nocturnal leg cramps. Quinine was also implicated by the finding of quinine-dependent antibodies reactive with platelets, granulocytes, and erythrocytes in the serum of both patients. Clearly these patients had quinine-induced hemolytic uremic syndrome, a recently described syndrome [2] that can occur with or without associated disseminated intravascular coagulation or granulocytopenia [34].

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