Postendoscopic retrograde cholangiopancreatography pancreatitis

Abstract

Endothelial injury is perhaps the inciting factor leading to the microangiopathic process that initiates thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS). TTP-HUS after postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is extremely rare, but potentially is life threatening. Here, we describe a case of a 23-year-old man with a history of choledocholithiasis, who developed TTP-HUS, 2 days after the onset of post-ERCP pancreatitis. It is important that physicians recognize TTP-HUS as one of the potential causes of acute kidney injury in cases of acute pancreatitis and post-ERCP pancreatitis for adult patients, especially when there is concomitant thrombocytopenia and hemolytic anemia. The early initiation of plasma exchange has a major impact on the survival and preservation of renal function. Exchange transfusion of fresh frozen plasma remains the cornerstone treatment of TTP-HUS.

Haemolytic uraemic syndrome associated with pancreatitis: report of four cases and review of the literature

“…Thirty-two cases of HUS associated with pancreatitis have been reported in the literature since 1978 [ 6 , 11–15 , 19–36 ]. Table 1 summarizes the main clinical characteristics and outcomes of these patients.…”

“…The association between pancreatitis and HUS has been reported both in paediatric and adult populations [ 11–15 , 19–36 ]. According to the literature review conducted in this study, the most frequent clinical profile of patients with the association of HUS and acute pancreatitis was middle-aged males with a recent history of alcohol intake.…”

“…Several case reports of HUS following acute pancreatitis have hitherto been published [ 11–15 ]; however, the information about its management and the main outcomes of this pathological condition are scarce.…”

The perfect storm: Thrombotic thrombocytopenic purpura (TTP) associated with COVID‐19, a clinical case series and review

“…Our first patient had a family history of alpha‐thalassemia trait and a family history of autoimmune conditions including ITP, and we propose that ones genetics can predispose one to other autoimmune conditions. Additionally, this patient had cholangitis, and there has been a case report that describes cholangiopancreatography as a rare cause of TTP [18]. In this case, an association with COVID‐19 is in fact difficult to demonstrate since he had no symptoms of COVID‐19; therefore a close association with COVID‐19 is possible but cannot be confirmed.…”

“…Nonetheless, we surmise that there are two types of disease pathogenesis. Firstly, those with a prior COVID-19 infection, that is, who were IgG positive-we propose that the primary pathology is molec- Additionally, this patient had cholangitis, and there has been a case report that describes cholangiopancreatography as a rare cause of TTP [18]. In this case, an association with COVID- for more severe disease [20].…”