ABSTRACT
Thrombocytopenic thrombotic purpura (TTP) is a thrombotic microangiopathy associated with hematopoietic stem cells transplantation, pregnancy, puerperium, drugs, bloody diarrhea, a heterogeneous group of illnesses, such as malignant hypertension, autoimmune and neoplastic diseases, infections, and an idiopathic group that includes the pathologies that don't apply for the preceding clinical categories. Tuberculosis is an illness of intermediate incidence in Argentina, with increased frequency in high-risk groups. In this article, we present the case of a 60 years old male patient, with abdominal pain, cough and nocturnal sweating. He was diagnosed as having thrombocytopenia, and a few days later, microangiopathic anemia and TTP. Further examinations led TBC diagnosis based on: 1) acid fast bacillus (+++) for Ziehl Neelsen stain in bronco alveolar lavage, 2) laryngeal lesion and 3) ileocecal valve lesion. We report this case, because TBC has rarely been associated with TTP in medical literature.
Subject(s)
Purpura, Thrombotic Thrombocytopenic/complications , Purpura, Thrombotic Thrombocytopenic/diagnosis , Tuberculosis/diagnosis , Humans , Male , Middle Aged , Tuberculosis/complicationsABSTRACT
La púrpura trombótica trombocitopénica (PTT) es una microangiopatía trombótica asociada a cuadros de trasplante de células madre hematopoyéticas, embarazo y posparto, al uso de ciertas drogas, diarrea sanguinolenta, a un grupo heterogéneo de trastornos como enfermedades autoinmunes, hipertensión maligna, enfermedades neoplásicas, diversas infecciones y un grupo llamado idiopático, donde se incluyen aquellos en quienes no se cumplieron los criterios de las categorías clínicas anteriores. La tuberculosis (TBC) es una enfermedad de incidencia intermedia en Argentina, más frecuente en determinados grupos poblacionales. Presentamos el caso de un varón de 60 años que consulta por dolor abdominal, tos y sudoración nocturna; se detectó primero trombocitopenia y luego de algunos días anemia microangiopática, lo que llevó al diagnóstico de PTT. Posteriormente, al continuar con la evaluación, se diagnosticó TBC por: 1) baciloscopia positiva para bacilos ácido-alcohol resistentes (+++) por técnica de Ziehl Neelsen en lavado broncoalveolar, 2) lesiones en laringe y 3) lesiones en válvula ileocecal. La TBC ha sido pocas veces asociada con la PTT en la literatura, razón por la cual presentamos este caso.
Thrombocytopenic thrombotic purpura (TTP) is a thrombotic microangiopathy associated with hematopoietic stem cells transplantation, pregnancy, puerperium, drugs, bloody diarrhea, a heterogeneous group of illnesses, such as malignant hypertension, autoimmune and neoplastic diseases, infections, and an idiopathic group that includes the pathologies that don’t apply for the preceding clinical categories. Tuberculosis is an illness of intermediate incidence in Argentina, with increased frequency in high-risk groups. In this article, we present the case of a 60 years old male patient, with abdominal pain, cough and nocturnal sweating. He was diagnosed as having thrombocytopenia, and a few days later, microangiopathic anemia and TTP. Further examinations led TBC diagnosis based on: 1) acid fast bacillus (+++) for Ziehl Neelsen stain in bronco alveolar lavage, 2) laryngeal lesion and 3) ileocecal valve lesion. We report this case, because TBC has rarely been associated with TTP in medical literature.
Subject(s)
Humans , Male , Middle Aged , Purpura, Thrombotic Thrombocytopenic/complications , Purpura, Thrombotic Thrombocytopenic/diagnosis , Tuberculosis/diagnosis , Tuberculosis/complicationsABSTRACT
Thrombotic thrombocytopenic purpura(TTP) is an uncommon fatal disorder of young adults characterized by thrombocytopenia, microangiopathic hemolytic anemia, fluctuating neurologic dysfunction, fever, and renal dysfunction. The fluctuating neurologic dysfunction, which is mainly due to small arteriolar or capillary ischemic vasculopathy, suggests impending stroke. We report a 72-year-old woman who has had recurrent and progressive transient ischemic attacks and confusion after a large amount of bloodletting. She recovered completely after intensive plasmapheresis and immunosuppressant treatment. This case illustrates that aggressive treatment, even in old age, may prevent permanent neurologic deficits when stroke is impending and complicated by TTP.
Subject(s)
Aged , Female , Humans , Young Adult , Anemia, Hemolytic , Bloodletting , Capillaries , Fever , Ischemic Attack, Transient , Neurologic Manifestations , Plasmapheresis , Purpura, Thrombotic Thrombocytopenic , Stroke , ThrombocytopeniaABSTRACT
La púrpura trombocitopénica trombótica (PTT) es una enfermedad caracterizada por anemia hemolítica microangiopática, trombocitopenia, manifestaciones neurológicas fluctuantes y trastornos renales. La oclusión de arteriolas y capilares por microtrombos compuestos fundamentalmente por plaquetas, es típica de este trastorno, y consecuencia de la presencia de grandes multímeros de factor von Willebrand (Fv W), presumiblemente debido a la disminución de la actividad de la enzima ADAMTS13, encargada de escindir estos multímeros. El diagnóstico precoz de la PTT permite un tratamiento rápido y eficaz de este trastorno, elemento decisivo para evitar la evolución fatal de estos enfermos. La presencia de anemia y trombocitopenia no explicada por otros procesos patológicos, debe hacer sospechar el diagnóstico. El recambio plasmático es la terapéutica más efectiva y se considera el tratamiento de elección de la PTT. El uso de inmunosupresores asociados con el recambio plasmático ha sido recomendado en algunos casos. En la actualidad, el Rituximab se considera un tratamiento adicional de la PTT.
The thrombocytopenic thrombotic purpura is a disease characterized by microangiopathic hemolytic anemia, thombocytopenia , fluctuating neurological manifestations, and renal disorders. The occlusion of arterioles and capillars by microthrombi mainly composed of platelets is typical of this disorder and a consequence of the presence of large von Willebrand factor multimers, due presumptively to the reduction of the activity of the enzyme ADAMTS13 that is in charge of splitting these multimers.The early diagnosis of TTP allows a fast and efficient treatment of this disorder, a decisive element to prevent the fatal evolution of these patients. The presence of anemia and thrombocytopenia nonexplained by other pathological processes makes us suspect the diagnosis. The plasmatic turnover is the most effective therapeutics, and it should be considered the elective treatment of TTP. The use of immunosuppressors associated with the plasmatic turnover has been recommended in some cases. Nowadays, rituximab is regarded as an additional treatment of TTP.