Gemcitabine-sirolimus synergy associated thrombotic microangiopathy in a renal transplant recipient with mesenteric leiomyosarcoma: A case report

Figure 1 Contrast enhanced computed tomography of the abdomen demonstrating a 5. 7 cm × 7.3 cm × 6.7 cm solid, progressively enhancing mass in the left hemi-abdomen, suspicious for a mesenchymal tumor.

Figure 2 Immunohistochemical stains. A: Arteriole with intraluminal fibrin thrombus (arrowhead); B: Silver-stained glomerulus with mesangiolysis (arrowhead); C: Mesangiolysis, endothelial cell swelling, and capillary wall remodeling with formation of double contours (arrowhead); D: Capillary wall remodeling with double contours (arrowhead).

Figure 3 Chronological sequence of major clinical events in relation to thrombotic microangiopathy presentation. TMA: Thrombotic microangiopathy.

Figure 4 Increasing trend in serum creatinine from the time of presentation. The green arrow indicates initiation of eculizumab and subsequent dosing, and the orange arrow shows the occurrence of bacterial meningitis.