A Rare Case of Thrombotic Thrombocytopenic Purpura Caused by Pancreatitis and Clopidogrel

Abstract

Patient: Male, 71Final Diagnosis: Thrombotic thrombocytopenic purpuraSymptoms: Abdominal and/or epigastric painMedication: —Clinical Procedure: —Specialty: General and Internal MedicineObjective:Rare co-existance of disease or pathologyBackground: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.

Acquired Thrombotic Thrombocytopenic Thrombocytopenia Presenting As Urinary Tract Infection and Perianal Abscess: A Case Review

“…Thrombotic thrombocytopenic thrombocytopenia is a microangiopathic hemolytic anemia syndrome accompanied by thrombocytopenia, renal insufficiency, fever, and neurological disorders [3]. Although it can be inherited, acquired thrombotic thrombocytopenic thrombocytopenia is primarily idiopathic and may be attributed to various inflammatory conditions (e.g., hepatitis C, pneumonia, HIV, and sepsis), medications such as mitomycin C, and chronic diseases such as malignancies [3].…”

A Rare Case of Thrombotic Thrombocytopenic Purpura Caused by Acute Pancreatitis

“…malignancies, cirrhosis, connective tissue disorders, ulcerative colitis, diabetes mellitus, and hyperthyroidism). 2 Acute pancreatitis is one of the rare causes of TTP. Systemic inflammatory response due to inflammatory cytokines (secondary to acute pancreatitis), microvascular damage caused by the complement system activated by pancreatic enzymes, and ADAMTS-13 deficiency are held responsible in the pathophysiology of this disease.…”

“…4,8 The mean time between the diagnosis of TTP and the diagnosis of acute pancreatitis was reported to be 2-3 days. 2,3 Our patient was presented with an acute pancreatitis clinic. She was diagnosed with TTP and an acute pancreatitis at the same time, with thrombocytopenia and peripheral smear findings at presentation.…”

“…TTP development, due to the use of clopidogrel, begins within 2 weeks and its mortality is around 10-20%. 2 Antiplatelet therapy change is required in the treatment and, although, it is a rare condition, it…”