A dramatic recovery in a patient initially expected to die of TTP & its complications

Abstract

Thrombotic thrombocytopenic purpura (TTP) has a high fatality rate if not caught early and treated with plasmapheresis. When TTP patients present late in their sequelae with neuro symptoms, an elevated lactate dehydrogenase and systemic symptoms, there is a high mortality rate. This report describes the case of a young female who had no significant medical problems and presented to our hospital after several days of hematuria, new onset blurry vision and dizziness. She was found to have thrombocytopenia and microangiopathic hemolytic anemia consistent with TTP and was thus started on plasmapheresis. Her course was further complicated with seizures and development of bilateral basal ganglia infarcts which lead to the need for mechanical ventilation. This was followed by worsening renal functions which was managed with intermittent hemodialysis. To add to her multi-organ failure, she developed shock liver along with demand ischemia evidenced by significant elevations in liver enzymes and troponin leaks, respectively. However, on Day 4 it was fascinating to see the beginning of her recovery pathway. It began with response to simple commands followed by discontinuing invasive ventilation and gradual improvement in her renal functions evidenced by increasing urine output. Soon her platelets started rising consistently and she did not require plasmapheresis or hemodialysis by the time she was discharged. This case highlights the rapid recovery of a young female with new onset TTP which was complicated by involvement and severe damage of more than five different organs but was followed by complete recovery of each organ system.

Keywords

• Thrombotic thrombocytopenic purpura
• recovery
• plasmapharesis
• rituximab
• good response
• multi organ failure