High-dose verapamil + trandolapril-induced thrombotic microangiopathy.

Thrombotic microangiopathy (TMA) is a syndrome characterized by microangiopathic haemolytic anaemia, thrombocytopenia, and several variable signs of organ damage due to the platelet thrombi in the microcirculation. This article reports a case with TMA which developed after ingestion of a high-dose combination of verapamil and trandolapril. To the authors' knowledge, no prior cases of TMA induced by trandolapril (an angiotensin-converting enzyme inhibitor) and verapamil (a calcium channel blocker) have been reported in the literature.