Adverse events of drug therapy , Rare co-existance of disease or pathology
Muhammad Shabbir Rawala, S. Tahira Shah Naqvi, Muhammad Yasir Khan, Amr El Toukhy
(Department of Internal Medicine, Charleston Area Medical Center, Charleston, USA)
Am J Case Rep 2018; 19:1288-1291
Thrombotic thrombocytopenic purpura is mostly characterized by symptoms and signs of hemolytic anemia, thrombocytopenia, renal impairment, fever and neurologic dysfunction. It is not always necessary to have all 5 characteristic symptoms, and presentations can vary. It can be congenital or acquired by any etiology that causes deficiency or dysfunction of ADAMST13 enzyme.
CASE REPORT: We present a case of a 71-year-old man who presented to our hospital initially with abdominal pain. He was diagnosed with pancreatitis, and conservative management was started with pain control and hydration. During the hospital course, the patient developed anemia that was hemolytic in nature, acute kidney injury and thrombocytopenia. He was then diagnosed as having TTP secondary to pancreatitis with additive effect of clopidogrel, as he had recently been started on clopidogrel due to percutaneous coronary intervention. He was started on prompt treatment with plasma exchange and intermittent dialysis, and he achieved full recovery after that.
CONCLUSIONS: TTP is a potentially fatal disease with high mortality risk. It is judicious to recognize and have high suspicion of TTP being caused by such rare causes (pancreatitis and clopidogrel), as immediate recognition and treatment can enhance survival.
Keywords: acute kidney injury, Pancreatitis, Platelet Aggregation Inhibitors, Purpura, Thrombotic Thrombocytopenic, Thrombocytopenia