Although quinine is an infrequently prescribed drug, with malaria treatment being its only FDA-approved indication, unwitting exposure via beverages (e.g., tonic water), over the counter herbal remedies and illegal recreation drugs still occur. We present a unique case of a female patient who denied any known prior history of quinine exposure, who after being prescribed quinine tablets for restless leg syndrome, developed an immune-related thrombotic microangiopathy with thrombocytopenia and subsequent multi-organ failure. It was later elucidated that her only known potential source of prior quinine exposure was a remote history of crack-cocaine use. The patient survived this rare and severe inflammatory response with recovery of renal function and was able to discontinue dialysis.


• Quinine • TMA • drug reaction • DITMA • thrombocytopenia