Immunologic thrombocytopenia followed by thrombotic thrombocytopenic purpura in two HIV₁ patients

Abstract

Two homosexual HIV1-positive male patients with thrombotic thrombopenic purpura (TTP) were found to have past history of immune thrombocytopenia (ITP). The first patient had ITP 10 months prior to TTP and was successfully treated by splenectomy. The second patient had ITP 32 months before TTP. No specific treatment was given for his asymptomatic ITP. Association of HIV infection to TTP seems to be frequent. These two types of purpura have different pathogenic mechanisms but share a common altered immune response to antigenic challenge. The occurrence of ITP and TTP in HIV-positive patients may lead to errors in diagnosis and therapy.

Thrombotic thrombocytopenic purpura in autoimmune hepatitis

“…The prednisone administered as a treatment for AIH was also effective for the thrombocytopenia. The association between TTP and idiopathic thrombocytopenic purpura (ITP) has been reported previously in HIVpositive patients, 14,15 and during pregnancy. 16 The following observations may explain why ITP and TTP are associated in HIV-infected patients: 15 platelet glycoproteins are altered by direct viral infection, and vascular endothelial cells are damaged by direct HIV infection or by the promotion of interleukin-2 secretion by CD4 cells.…”

Thrombotic microangiopathy as first manifestation of acute human immunodeficiency virus infection: a case report and review of the literature

“…The most frequent hematological findings in this condition are changes to peripheral blood cells, although coagulation disorders may also occur. Furthermore, the coexistence of immunological-mediated thrombocytopenia with TTP has been reported in chronic HIV infection [ 5 ].…”

Idiopathic thrombocytopenic purpura: Pathophysiology and management

“…These overlapping syndromes are not yet well recognized but are more frequently described in patients with HIV and HTLV-I infection [16]. When manifesting ITP, they respond well to GC, much like classic ITP; but when manifesting TTP, GC is ineffective while exchange plasmaphresis/plasma infusion is required, as in classical TTP.…”