AN occurs with a high prevalence in Latin American youths, and its prevalence is much higher in a "non-classical" and ignored location where it is very easy to detect during physical examination: the knuckles. It may also occur earlier in this location in the evolution to obesity. The presence of AN in the knuckles in any patient, even if they have a normal body mass index, might indicate the likelihood of an early clinical manifestation of insulin resistance and metabolic consequences.

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Thrombotic thrombocytopenic purpura (TTP) is a disease with a high rate of mortality if a proper treatment is not instated. Plasmapheresis with plasmatic exchange is the treatment of choice. Diagnosis is performed demonstrating microangiopathic hemolytic anemia, a negative direct Coombs test and thrombocytopenia. Among the clinical data, neurological and renal alterations stand out. When there is a reasonable suspicion in the diagnosis, plasmapheresis must be initiated immediately. There are different diseases that may be similar to the TTP signs and symptoms, especially in pregnant women. TTP has a high risk of relapse and may leave sequelae.