The Spectrum of Thrombotic Thrombocytopenic Purpura: A Clinicopathologic Demonstration of Tacrolimus-Induced Thrombotic Thrombocytopenic Purpura in a Lung Transplant Patient

Abstract

Immunosuppressive drugs used post-transplantation are among the most common causes of thrombotic thrombocytopenic purpura (TTP). Diagnosis is often confounded not only by its myriad presentations, but also because these manifestations may be explained by the comorbidities or complications of transplantation. A 61-year-old female who had a single lung transplant for severe chronic obstructive pulmonary disease maintained on corticosteroids, tacrolimus and mycophenolate mofetil, was admitted for fever, headache with confusion and lethargy. She was mildly anemic and thrombocytopenic. Peripheral smear showed rare fragmented red cells. Muddy brown casts were present on urinalysis. She was diagnosed with TTP. Tacrolimus was discontinued and the mental status of the patient, anemia and thrombocytopenia improved significantly.

Rare causes of hyperbilirubinemia after lung transplantation: our experience at a single center

“…Although causes of hyperbilirubinemia can vary widely (3,4), only few cases of hyperbilirubinemia with rare causes after lung transplantation have been reported (14,15,(29)(30)(31). Furthermore, we did not find any reports on the association of lung transplantation with ischemic cholangiopathy.…”

De novo thrombotic microangiopathy after non-renal solid organ transplantation

“…Four case series and 10 case reports were found, including a total of 63 adult lung transplant recipients [14,[47][48][49][50][51][52][53][54][55][56].…”

Review: immunosuppression for the lung transplant patient

“…CNIs can injure endothelial cells, cause vasoconstriction and increase platelet aggregation resulting in TTP (58). Neurological symptoms or a decline in renal function may be attributed to CNI-related neurotoxicity or nephrotoxicity confounding a TTP diagnosis (59). TTP can occur at any time post LTx and is independent of levels, with the highest risk when an mTOR inhibitor is used in conjunction with a CNI (58).…”