Thrombotic Thrombocytopenic Purpura (TTP) in a Female Patient with Multiple Sclerosis – a Case Report

Czech version

Authors: P. Praksová; P. Štourač; J. Bednařík
Authors‘ workplace: Neurologická klinika LF MU a FN Brno
Published in: Cesk Slov Neurol N 2009; 72/105(1): 69-71
Category: Case Report

Overview

The authors report a case of 37-year old woman with multiple sclerosis who developed severe thrombocytopenia, anemia, renal insufficiency and neurological symptoms. The disease was classified as an attack of thrombotic thrombocytopenic purpura (TTP). Interferon beta and azathioprine therapy was discontinued due to possible association with the development of TTP. The patient was treated with corticosteroids, with a good therapeutic result. After 10 months, the attack of thrombotic thrombocytopenic purpura recurred. The article describes the principal clinical symptoms of this rare, but serious disorder.

Key words:
sclerosis multiplex – thrombocytopenia – microangiopathic hemolytic anemia – metaloproteinasis ADAMTS13 – thrombotic thrombocytopenic purpura

Sources

1. Casilda M. Balmareda: Thrombotic Thrombocytopenic Purpura, Haematologic and Related Diseases. In: Rolland LP (ed). Merritt’s Neurology. 11th ed. Philadelphia: Lippincott Williams and Wilkins 2005: 1053–1054.

2. Zheng XL, Sadler JE. Pathogenesis of Thrombotic Microangiopathies. Annu Rev Pathol 2008; 3: 249–277.

3. Moake JL. Thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome. Arch Pathol Lab Med 2002; 126(11): 1430–1433.

4. Zimrin AB. Thrombotic thrombocytopenic purpura: Going with the evidence. Crit Care Med 2006; 34(8): 2247–2248.

5. George JN. The role of ADAMTS13 in the pathogenesis of thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clin Adv Hematol Oncol 2005; 3(8): 627–632.

6. Raanani P, Ben-Bassat I. Immune-mediated complications during interferon therapy in hematological patients. Acta Haematologica 2002; 107(3): 133–144.

7. Walther EU, Hohlfeld R. Multiple sclerosis: side effects of interferon beta therapy and their management. Neurology 1999; 53(8): 1622–1627.

8. Yarranton H, Machin SJ. An update on the pathogenesis and management of acquired thrombotic thrombocytopenic purpura. Curr Opin Neurol 2003; 16(3): 367–373.

9. Cataland SR, Wu HM. Immunotherapy for thrombotic thrombocytopenic purpura. Curr Opin Hematol 2005; 12(5): 359–363.

10. Fearing MK, Spar MD, Kahn MJ. Chronic thrombotic thrombocytopenic purpura masquerading as other disease entities. J La State Med Soc 1998; 150(1): 29–31.