2020 Volume 53 Issue 5 Pages 259-264
The patient was a 73-year-old male, who had been receiving nafamostat mesilate (NM) as an anticoagulant during hemodialysis (because he was positive for heparin-induced thrombocytopenia antibodies) since he was started on hemodialysis in X−9. In X, he developed a recurrent fever after undergoing hemodialysis. His blood culture results were negative. His condition did not improve after the administration of antimicrobial agents. Although pancytopenia was observed, and the patient was diagnosed with myelodysplastic syndrome based on the detection of chromosomal aberrations and a reduced number of blasts during a bone marrow biopsy, this was not considered to be a likely cause of the fever. The fever was resolved by changing the anticoagulant from NM to argatroban 36 days after its onset, and the patient was diagnosed with a drug-induced fever due to NM. To the best of our knowledge, no previous studies have described drug allergies caused by the continuous, prolonged (9-year) use of NM, as was described in our case. With age and surgical treatment, hemorrhagic complications tend to increase in dialysis patients, and the likelihood of NM being used also increases. We reported a unique case that demonstrated that NM can cause allergies, even during its long-term continuous use.
