A case of “smoldering” immune‐mediated thrombotic thrombocytopenic purpura manifesting as recurrent cardioembolic stroke

We report an atypical manifestation of immune-mediated thrombotic thrombocytopenic purpura (TTP) that we hypothesize represents a longstanding, or “smoldering,” process. As typified by this case, the prompt recognition and treatment for immune-mediated TTP are often confounded by clinical comorbidities. Thus, TTP should be considered in cases of unremitting thrombocytopenia of unknown origin in patients with stroke or other thrombosis. AbstractPrompt recognition and treatment for thrombotic thrombocytopenic purpura (TTP) are critical to prevent the irreversible manifestations of this rare and quickly fatal hematologic disorder. Untreated TTP is typically a rapid-onset disease with mortality exceeding 90% within days in the absence of appropriate treatment. In the current report, we describe a case of immune-mediated TTP (iTTP) in a 62-year-old man manifesting as longstanding thrombocytopenia, recurrent cardioembolic strokes, and valvular thrombogenesis over a period of 3  years. We provide correlative evidence to support the potential contribution of adalimumab, a TNFα inhibitor, to the development of iTTP. We offer several educational insights regarding the identification of atypical presentations of iTTP owing to the longstanding disease course and numerous clin ical comorbidities seen in this patient.
Source: Clinical Case Reports - Category: General Medicine Authors: Tags: CASE REPORT Source Type: research