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Study Led by Yale Pathologists Shows Thrombotic Microangiopathy Should Be Considered Life-threatening Following Acute Diethylene Glycol Exposure

February 27, 2024

A rare case presented by Yale School of Medicine researchers of thrombotic microangiopathy (TMA) in a patient who ingested chafing fuel containing diethylene glycol shows that TMA should be considered as a potentially fatal complication in the setting of acute diethylene glycol poisoning.

The study was presented by Grace Malvar, MD, former renal pathology fellow, Deepthi Gunasekaran, MD, assistant professor of medicine (nephrology), Nazanin Vaghari Mehr, MD, nephrology clinical fellow, Shuta Ishibe, MD, professor of medicine (nephrology), and Gilbert Moeckel, MD, PhD, professor of pathology and director of the Renal Transplant Pathology and Electron Microscopy Laboratory.

A study on the case, published recently in the journal Kidney Medicine and presented by the publication as a Kidney Biopsy Teaching Case, involved a male patient in his 50s with a history of alcohol use disorder and chronic pancreatitis. The patient’s wife reported he had a relapse with severe alcohol cravings and consumed small amounts of hand sanitizer (isopropyl alcohol) and chafing fuel (diethylene glycol) in their basement.

Diethylene glycol, a clear liquid widely used as a solvent in numerous consumer products, including brake fluid and antifreeze, is highly toxic to the kidney and brain, and ingesting it can cause acute kidney injury (AKI) as well as neurologic symptoms, including acute flaccid paralysis, cranial nerve palsies, and encephalopathy. It has been implicated in mass poisonings, and the incidence of AKI in diethylene glycol poisonings is linked to high-mortality rates.

The patient, who died after 19 days in the hospital, showed a typical clinical course of initial gastrointestinal symptoms followed by AKI and peripheral sensorimotor neuropathy. A kidney biopsy showed TMA and diffuse acute tubular injury. The case demonstrates TMA as a possible life-threatening complication of acute diethylene glycol poisoning. It is therefore plausible that patients with a genetic predisposition to endothelial injury may develop TMA following diethylene glycol exposure, the study concludes.

Submitted by Terence P. Corcoran on February 27, 2024