scholarly journals A Rare Case of Aluminum Phosphide Induced Thrombotic Thrombocytopenic Purpura

2021 ◽  
Author(s):  
Nafiseh Alizadeh ◽  
Mina Borran ◽  
Behnam Behnoosh ◽  
Mehrnoush Dianatkhah
Keyword(s):  
Developing Countries ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Rare Case ◽  
Attempted Suicide ◽  
Patient Evaluation ◽  
Intravascular Hemolysis ◽  
Successful Management ◽  
Aluminum Phosphide ◽  
Thrombocytopenic Purpura ◽  
First Case

Aluminum phosphide (AlP) has remained a chemical cause of completed suicides in some developing countries. ALP toxicity can cause multi-system damage. As far as we know, this is the first case of ALP-induced Thrombotic Thrombocytopenic Purpura (TTP) and its successful management. A 34-year-old man, who had attempted suicide with ALP was admitted to our hospital. On the 3rd day of admission, the patient developed hematuria, hemolysis, and thrombocytopenia. Based upon available evidence, TTP was diagnosed. Following a complete patient evaluation, ALP was recognized as the probable cause of TTP. Following the treatment using prednisolone and therapeutic plasma exchange, the patient substantially improved. Finally, he was discharged on the 22nd day. Toxin-induced intravascular hemolysis should be considered for patients presenting with ALP toxicity. As reported in this patient, TTP is another manageable consequence of ALP poisoning.

scholarly journals An Early Unexpected Immune Thrombotic Thrombocytopenic Purpura Relapse Associated with SARS-CoV-2 Infection: A Case Report and Literature Review

2021 ◽  
pp. 1-5
Author(s):  
Maya Kornowski Cohen ◽  
Liron Sheena ◽  
Yair Shafir ◽  
Vered Yahalom ◽  
Anat Gafter-Gvili ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Case Report ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Lupus Erythematosus ◽  
Response To Therapy ◽  
Intravascular Hemolysis ◽  
Systemic Lupus ◽  
Thrombocytopenic Purpura ◽  
History Of ◽  
Triggering Factor

SARS-CoV-2 has been reported as a possible triggering factor for the development of several autoimmune diseases and inflammatory dysregulation. Here, we present a case report of a woman with a history of systemic lupus erythematosus and antiphospholipid syndrome, presenting with concurrent COVID-19 infection and immune thrombotic thrombocytopenic purpura (TTP). The patient was treated with plasma exchange, steroids, and caplacizumab with initial good response to therapy. The course of both TTP and COVID-19 disease was mild. However, after ADAMTS-13 activity was normalized, the patient experienced an early unexpected TTP relapse manifested by intravascular hemolysis with stable platelet counts requiring further treatment. Only 3 cases of COVID-19 associated TTP were reported in the literature thus far. We summarize the literature and suggest that COVID-19 could act as a trigger for TTP, with good outcomes if recognized and treated early.

scholarly journals Ciprofloxacin-Induced Thrombotic Thrombocytopenic Purpura: A Case of Successful Treatment and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Hafiz Rizwan Talib Hashmi ◽  
Gilda Diaz-Fuentes ◽  
Preeti Jadhav ◽  
Misbahuddin Khaja
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
African American Woman ◽  
American Woman ◽  
Successful Outcome ◽  
Peripheral Smear ◽  
Thrombocytopenic Purpura ◽  
Aggressive Management ◽  
First Case ◽  
High Index Of Suspicion ◽  
Elevated Lactate

A 49-year-old African American woman was admitted to our hospital with abdominal pain, nausea, vomiting, lethargy, and confusion. She was receiving ciprofloxacin for a urinary-tract infection prior to admission. Laboratory examination revealed anemia, thrombocytopenia, elevated lactate dehydrogenase, and serum creatinine. Peripheral smear showed numerous schistocytes, and the patient was diagnosed with thrombotic thrombocytopenic purpura (TTP). Ciprofloxacin was identified as the offending agent. The patient received treatment with steroids and plasmapheresis, which led to rapid clinical recovery. This is the first case to our knowledge of successfully treated ciprofloxacin-induced TTP; previously reported cases had fulminant outcomes. Quinolones are an important part of the antibiotic armamentarium, and this case can raise awareness of the association between quinolones and TTP. A high index of suspicion for detection and early and aggressive management are vitally important for a successful outcome.

Severe primary refractory thrombotic thrombocytopenic purpura (TTP) in the post plasma exchange (PEX) and rituximab era

2020 ◽  
Vol 13 (6) ◽  
pp. e234091
Author(s):  
Sowmya Goranta ◽  
Smit S Deliwala ◽  
Tarek Haykal ◽  
Ghassan Bachuwa
Keyword(s):  
Effective Treatment ◽  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Clinical Remission ◽  
Rare Case ◽  
Platelet Response ◽  
Treatment Intensification ◽  
Thrombocytopenic Purpura ◽  
Need For Treatment ◽  
Emerging Therapies

Acute acquired thrombotic thrombocytopenic purpura (TTP) requires prompt recognition and initiation of plasma exchange (PEX) therapy and immunosuppression. When PEX fails, mortality nears 100%, making finding an effective treatment crucial. Primary refractory TTP occurs when initial therapies fail or if exacerbations occur during PEX therapy, both signifying the need for treatment intensification to achieve clinical remission. Rituximab helps treat most of the refractory TTP cases, except those that are severely refractory. A paucity of studies guiding severely refractory TTP makes management arbitrary and individualised, highlighting the value of isolated reports. We present an extremely rare case of primary refractory TTP with an insufficient platelet response to numerous types of treatments, including emerging therapies such as caplacizumab, on the background of repeated PEX and immunosuppressive therapies.

Ciprofloxacin-induced Thrombotic Thrombocytopenic Purpura: A Rare Case

2015 ◽  
Vol 110 ◽  
pp. S437
Author(s):  
Imran Ashraf ◽  
Bhupinder Romana ◽  
Umair Sohail ◽  
Ashraf Almashhrawi ◽  
Rubayat Rahman ◽  
...  
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Rare Case ◽  
Thrombocytopenic Purpura

Cetuximab-induced thrombotic thrombocytopenic purpura in a patient with a resected squamous cell carcinoma of the lip

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14155-14155
Author(s):  
F. Rosen ◽  
T. Lad ◽  
M. Telfer ◽  
R. Catchatourian ◽  
B. Yim ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Platelet Count ◽  
Cell Carcinoma ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Squamous Cell ◽  
Egf Receptor ◽  
Endothelial Damage ◽  
Thrombocytopenic Purpura ◽  
Normal Peripheral Blood ◽  
First Case

14155 Background: Chemotherapy-associated thrombotic thrombocytopenic purpura (TTP) has been described in the literature. However Cetuximab, a monoclonal antibody targeted to the EGF receptor, has not yet been associated with TTP. We report a case of an 85 year old woman with a resected squamous cell carcinoma of the lip who developed TTP after receiving cetuximab. Methods: A day after receiving Cetuximab, as part of an adjuvant concurrent cetuximab-radiotherapy regimen, the patient presented with gingival bleeding and confusion without fever but with significant petechial rash and jaundice.. Hemoglobin level was 6.9 g/dL WBC 3.9 k/uL Platelet count 4 k/uL Lactate dehydrogenase 1350 U/L Indirect bilirubin 3.8 mg/dL Haptoglobulin < 6 mg/dL Reticulocyte count 4.4 %. Serum creatinine, ANA, coagulation profile, coomb‘s test were normal. Peripheral blood smear showed 3+ schistocytes. TTP was diagnosed and daily plasmapheresis was initiated. TTP resolved after 8 sessions of plasmapheresis with platelet count increasing to 446 k/uL and sustained. Results: Competing etiologies for our patient’s TTP were cancer and cetuximab. Most reported cases of cancer-associated TTP occurred in patients with metastatic adenocarcinoma. Our patient had a non-metastatic resected squamous cell carcinoma with only residual microscopic disease. Since TTP developed closely following cetuximab administration and resolved with plasmapheresis after stopping cetuximab, we concluded that its development was most likely secondary to cetuximab or to antibody developed to it. Possible mechanisms for cetuximab-induced TTP are direct endothelial damage by cetuximab leading to platelet activation and aggregation or inhibition of metalloproteinase, resulting in accumulation of Ultra-large VWF multimers. Conclusions: Targeted-therapy is emerging as an effective treatment modality in medical-oncology. Further clinical experience is needed to ascertain the full extent of potentially fatal adverse events. To our knowledge this is the first case of cetuximab-induced TTP. No significant financial relationships to disclose.

scholarly journals A Rare Case of Thrombotic Thrombocytopenic Purpura Caused by Acute Pancreatitis

2021 ◽  
Vol 51 (2) ◽  
Author(s):  
Emin Gemcioglu ◽  
Mehmet Kayaalp ◽  
Merve Caglayan ◽  
Ahmet Ceylan ◽  
Mehmet Sezgin Pepeler
Keyword(s):  
Renal Failure ◽  
Acute Pancreatitis ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Hemolytic Anemia ◽  
Neurological Disorders ◽  
Rare Case ◽  
Rare Complication ◽  
Microangiopathic Hemolytic Anemia ◽  
Peripheral Smear ◽  
Thrombocytopenic Purpura

Thrombotic Thrombocytopenic Purpura is a syndrome of microangiopathic hemolytic anemia accompanied by thrombocytopenia, neurological disorders, renal failure and fever. Acute pancreatitis is a rare cause of Thrombotic Thrombocytopenic Purpura and this manifestation, at the same time, is a rare complication of acute pancreatitis. Thrombotic Thrombocytopenic Purpura is induced in acute pancreatitis by poorly understood mechanism, which involves multiple pathways apart from only ADAMTS-13 deficiency. Here, we analyze the case of a 47-year-old female who presented with an acute pancreatitis. She was diagnosed with Thrombotic Thrombocytopenic Purpura and an acute pancreatitis at the same time, with thrombocytopenia and peripheral smear findings at presentation. Therefore, Thrombotic Thrombocytopenic Purpura secondary to the pancreatitis was considered in this case. In this work, we have discussed details of our case and the different mechanisms involved in pathogenesis of Thrombotic Thrombocytopenic Purpura in acute pancreatitis and their outcome with prompt management.

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