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Tsuda R, Kido T, Okada I, Kobiyama A, Kawataka M, Yamazaki M, Asano R, Hounoki H, Shinoda K, Tobe K. Thrombotic thrombocytopenic purpura that developed 3 years after systemic lupus erythematosus had remitted with rituximab therapy. Mod Rheumatol Case Rep 2023; 8:57-62. [PMID: 37341710 DOI: 10.1093/mrcr/rxad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023]
Abstract
Patients with systemic lupus erythematosus (SLE) occasionally develop thrombotic thrombocytopenic purpura (TTP), which can be fatal. Here, we report a case of TTP developing 3 years after SLE remitted with rituximab (RTX) therapy. A 50-year-old woman was treated with RTX for marked immune thrombocytopenic purpura and autoimmune haemolytic anaemia due to SLE relapse. After induction of remission, she was treated with prednisolone alone without maintenance therapy with RTX. Approximately 3 years later, she was readmitted with marked thrombocytopenia and severe renal dysfunction. On admission, she was diagnosed with TTP for the first time based on severe reduction in a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) activity and detection of ADAMTS13 inhibitors. CD19+ B cells in the patient's serum increased to 34%, suggesting that B cells had reactivated once the effect of RTX had subsided. The patient was successfully treated with plasmapheresis, glucocorticoid pulse therapy, and RTX. There are no previous reports of newly diagnosed TTP with ADAMTS13 inhibitor production after having achieved remission of SLE with RTX. Therefore, our report also discusses the potential mechanisms of production of new autoantibodies after B-cell depletion therapy.
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Affiliation(s)
- Reina Tsuda
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Toshiki Kido
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Ikuma Okada
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Aoi Kobiyama
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Masatoshi Kawataka
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Miho Yamazaki
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Ryoko Asano
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hiroyuki Hounoki
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Shinoda
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
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Terasaki T, Kondo Y, Takahashi M, Tawara T, Fujita A, Yagi H, Kawai H, Noguchi M, Sato R, Terasaki M, Okamoto S, Toko H, Yagishita M, Takahashi H, Hagiwara S, Tsuboi H, Matsumoto I, Sumida T. Therapeutic Plasma Exchange Improved Pregnancy-associated Thrombotic Microangiopathy but not the Pregnancy Outcome in Patient with Systemic Lupus Erythematosus. Intern Med 2020; 59:3235-3238. [PMID: 32788531 PMCID: PMC7807106 DOI: 10.2169/internalmedicine.4655-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Thrombotic microangiopathy (TMA) is a rare but life-threatening complication of systemic lupus erythematosus (SLE) and is associated with adverse pregnancy outcomes. We herein report a 30-year-old pregnant woman with SLE complicated by TMA. Because her condition was unresponsive to initial corticosteroid and fresh-frozen plasma infusion treatment, we attempted plasma exchange (PE). Although thrombocytopenia and microangiopathic hemolytic anemia gradually improved, fetal death was confirmed at 23 weeks of gestation. This case suggests that PE is an effective therapeutic option but might be insufficient to maintain pregnancy in patients with SLE complicated by TMA.
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Affiliation(s)
- Toshihiko Terasaki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Mayumi Takahashi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Takashi Tawara
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Akiko Fujita
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroya Yagi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Japan
| | - Hitomi Kawai
- Department of Pathology, Institute of Basic Sciences, University of Tsukuba, Japan
| | - Masayuki Noguchi
- Department of Pathology, Institute of Basic Sciences, University of Tsukuba, Japan
| | - Ryota Sato
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Mayu Terasaki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Shota Okamoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hirofumi Toko
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Mizuki Yagishita
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroyuki Takahashi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Shinya Hagiwara
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroto Tsuboi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Isao Matsumoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
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Prasad C, Levy DM, Hebert D, Chami R, Teoh CW. An unusual etiology of thrombotic microangiopathy in an adolescent male: Answers. Pediatr Nephrol 2020; 35:1857-1864. [PMID: 32166357 DOI: 10.1007/s00467-020-04515-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Charushree Prasad
- Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Deborah M Levy
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Diane Hebert
- Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rose Chami
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Chia Wei Teoh
- Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. .,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Jiang H, An X, Li Y, Sun Y, Shen G, Tu Y, Tao J. Clinical features and prognostic factors of thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus: a literature review of 105 cases from 1999 to 2011. Clin Rheumatol 2013; 33:419-27. [PMID: 23954922 PMCID: PMC3937538 DOI: 10.1007/s10067-013-2312-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 05/29/2013] [Indexed: 11/30/2022]
Abstract
This study aims to review clinical features, treatments, and prognostic factors of thrombotic thrombocytopenic purpura (TTP) associated with systemic lupus erythematosus patients (sTTP). The case reports of sTTP published in world literature from 1999 to 2011 were collected, and 105 cases were divided into death group and survival group. The epidemiologic characteristics, clinical manifestations, laboratory examinations, treatments, and prognostic factors were analyzed. We found that coexistence of renal and neurological impairments were significantly frequent in the death group (100 %) than in the survival group (56.5 %) (P = 0.002). Type IV was predominant in 57.7 % of renal pathological damage, followed by type V (11.5 %), type II (5.8 %), and thrombotic microangiopathy (TMA) (5.8 %). TMA appeared more frequently (50 %) in the death group than in the survival group (6.25 %) (P = 0.042). End-stage renal disease occurred in nine cases with type IV in five (55.6 %), type TMA in one (11.1 %), and unspecified in three cases (33.3 %). Of 32 cases, 40.6 % showed severe ADAMTS13 deficiency and returned to normal or mildly deficient after remission. The total mortality rate of sTTP was 12.4 % and the mortality rate of patients with infection (27.3 %) was significantly higher than those without infection (8.4 %) (P = 0.028). Plasma exchange and glucocorticoids were administrated in over 80 % of cases with 65.7 % remission rate, while additional cytotoxics or rituximab was mostly used in refractory sTTP and achieved over 90 % of remission rate. Above all, coexistence of renal and neurological impairments, infection, and renal damage with type IV or TMA might denote a poor prognosis of sTTP.
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Affiliation(s)
- Honghao Jiang
- Department of Dermatology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1277 Jiefang Road, Wuhan, 430030, China
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Management of immune cytopenias in patients with systemic lupus erythematosus — Old and new. Autoimmun Rev 2013; 12:784-91. [DOI: 10.1016/j.autrev.2013.02.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/19/2013] [Indexed: 10/27/2022]
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Pons-Estel GJ, Serrano R, Lozano M, Cid J, Cervera R, Espinosa G. Recambio plasmático en las enfermedades autoinmunes sistémicas. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.semreu.2013.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Gharbi C, Bourry E, Rouvier P, Hacini S, Letaief A, Baumelou A, Izzedine H. Rapidly progressive lupus nephritis and concomitant thrombotic microangiopathy. Clin Exp Nephrol 2010; 14:487-91. [PMID: 20535626 DOI: 10.1007/s10157-010-0300-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 05/14/2010] [Indexed: 10/19/2022]
Abstract
Although uncommon, thrombotic microangiopathy (TMA) is one of the most serious complications in patients with systemic lupus erythematosus. A 30-year-old black woman admitted to our hospital because of fever, fatigue, 'dark' urine and rapidly progressive renal failure was found to have systemic lupus erythematous and atypical hemolytic uremic syndrome. Kidney biopsy showed WHO class IV lupus nephritis with crescents and TMA. Hemodialysis was initiated for worsening renal failure. The patient was treated with corticosteroids, monthly pulse intravenous Cyclophosphamide, plasmapheresis and Rituximab on a weekly basis for 4 weeks. The patient's blood pressure was aggressively controlled using antihypertensive agents. Despite this extensive therapy, she remained dialysis dependent although hematological parameters returned to normal values.
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Affiliation(s)
- Chems Gharbi
- Department of Nephrology, Pitié-Salpêtriere Hospital, Paris, France
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Yu F, Tan Y, Zhao MH. Lupus nephritis combined with renal injury due to thrombotic thrombocytopaenic purpura-haemolytic uraemic syndrome. Nephrol Dial Transplant 2009; 25:145-52. [PMID: 19703836 DOI: 10.1093/ndt/gfp421] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Thrombotic thrombocytopaenic purpura-haemolytic uraemic syndrome (TTP-HUS) in SLE was reported mainly in isolated case reports. The aim of this study is to investigate the clinical and pathological features, outcome and possible pathogenesis of TTP-HUS in patients with lupus nephritis. METHODS Clinical and renal histopathological data of patients with lupus nephritis were reviewed for clinical and pathological evidence of both TTP-HUS and renal thrombotic microangiopathy (TMA). Serum ADAMTS-13 activity and ADAMTS-13 autoantibodies were further studied. RESULTS Seven patients with evidence of both TTP-HUS and renal TMA were identified in 353 patients with lupus nephritis. In comparison with 55 patients with lupus nephritis without TTP-HUS, those with TTP-HUS had a higher prevalence of acute renal failure and worse renal outcome. The serum ADAMTS-13 activity was significantly lower in patients with both lupus nephritis and TTP-HUS than in patients with lupus nephritis only and in normal control (40% versus 69%, P = 0.012; 40% versus 81%, P < 0.001, respectively). The prevalence of ADAMTS-13 autoantibodies was significantly higher in patients with both lupus nephritis and TTP-HUS than in patients with lupus nephritis only and in normal control (6/7, 86% versus 10/55, 18%, P < 0.001; 6/7, 86% versus 0, P < 0.001, respectively). After clinical remission, the serum ADAMTS-13 activity of the seven patients with TTP-HUS increased significantly (40% versus 63%, P < 0.001) and five out of the six patients with positive ADAMTS-13 autoantibodies turned negative. CONCLUSIONS ADAMTS-13 autoantibodies might play an important role in the pathogenesis of TTP-HUS associated with lupus nephritis. The long-term outcome seems to be worse in patients with both TTP-HUS and lupus nephritis than in patients with lupus nephritis alone.
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Affiliation(s)
- Feng Yu
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University and Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, People's Republic of China
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Thrombotic thrombocytopenic purpura in systemic lupus erythematosus: risk factors and clinical outcome: a single centre study. Lupus 2009; 18:16-21. [DOI: 10.1177/0961203308094360] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study was undertaken to investigate clinical characteristics of thrombotic thrombocytopenic purpura (TTP) in patients with SLE and to determine risk factors and clinical outcome of TTP in patients with SLE. Among the 1203 patients with SLE admitted to catholic medical centre of the catholic university of Korea from January 1990 to December 2006, 26 patients with SLE were found to admit with TTP. TTP was defined if microangiopathic haemolytic anaemia, thrombocytopenia and negative Coombs’ test were present and when at least one of the following signs was noted: renal impairment, neurologic deficit or fever. Eighty-seven patients with SLE who admitted with other manifestations, matched for age and sex, were included as disease controls. Data were retrospectively analysed based on medical records. There were no significant demographic characteristics between SLE patients with TTP and those with other manifestations. Multivariate analysis showed that independent risk factors for the development of TTP included high SLE disease activity index score (SLEDAI > 10, P = 0.006) and coexisting nephritis ( P = 0.004). Among the 26 SLE patients with TTP, 12 died during admission period (in-hospital mortality rate: 46.1%). SLE patients with infection or neurologic manifestations had higher mortality rates. Multivariate analysis showed that infection is the only independent risk factor for mortality in SLE patients with TTP ( P = 0.035). Patients with SLE who are in the active stage or who have renal involvement have the increased risk for TTP. Development of TTP in patients with SLE can be fatal. Therefore, intensive therapy will be needed especially in the presence of infection.
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Abstract
The term thrombotic microangiopathy (TMA) encompasses a group of conditions that are defined by, or result from, a similar histopathological lesion. Hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), and several other conditions are associated with TMA. Distinguishing HUS from TTP is not always possible unless there are specific causes, such as Shiga toxin, Streptococcus pneumoniae, or a specific molecular defect such as factor H or ADAMTS13 deficiency. This review describes the forms of HUS/TTP that are not related to Shiga toxin, pneumococcal infection, genetic causes, or ADAMTS13 deficiency. Conditions include HUS/TTP associated with autoimmune disorders, human immunodeficiency virus (HIV) infection, transplantation, malignancy, and medications.
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Affiliation(s)
- Lawrence Copelovitch
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 USA
| | - Bernard S. Kaplan
- Department of Pediatrics, Division of Nephrology, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 USA
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MIYAMURA T, WATANABE H, TAKAHAMA S, SONOMOTO K, NAKAMURA M, ANDO H, MINAMI R, YAMAMOTO M, SUEMATSU E. Thrombotic thrombocytopenic purpura in patients with systemic lupus erythematosus. ACTA ACUST UNITED AC 2008; 31:159-65. [DOI: 10.2177/jsci.31.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tomoya MIYAMURA
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
| | - Hideyuki WATANABE
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
| | - Soichiro TAKAHAMA
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
| | - Koshiro SONOMOTO
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
| | - Masataka NAKAMURA
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
| | - Hitosi ANDO
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
| | - Rumi MINAMI
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
| | - Masahiro YAMAMOTO
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
| | - Eiichi SUEMATSU
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center
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Maruoka H, Koga T, Inoue Y, Honda S, Takeo M, Fukuda T, Aizawa H. Recurrent thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus. Mod Rheumatol 2007; 17:426-8. [DOI: 10.1007/s10165-007-0611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 05/24/2007] [Indexed: 10/22/2022]
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George JN, Vesely SK, James JA. Overlapping Features of Thrombotic Thrombocytopenic Purpura and Systemic Lupus Erythematosus. South Med J 2007; 100:512-4. [PMID: 17534089 DOI: 10.1097/smj.0b013e318046583f] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- James N George
- Hematology-Oncology Section, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA.
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Enami T, Suzuki T, Ito S, Yoshimi A, Sugihara M, Mamura M, Hayashi T, Goto D, Matsumoto I, Tsutsumi A, Sumida T. Successful treatment of refractory thrombotic thrombocytopenic purpura with cyclosporine and corticosteroids in a patient with systemic lupus erythematosus and antibodies to ADAMTS13. Intern Med 2007; 46:1033-7. [PMID: 17603247 DOI: 10.2169/internalmedicine.46.6192] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 46-year-old woman with systemic lupus erythematosus was hospitalized for purpura, hematochezia and hematuria. One week after admission, she developed grand mal seizures and coma and was diagnosed with thrombotic thrombocytopenic purpura (TTP) when fragmented red cells were found on the peripheral blood smear. Laboratory findings showed severe ADAMTS13 (a disintegrin-like and metalloprotease with thrombospondin type 1 repeats) deficiency and anti-ADAMTS13 antibodies, which in recent reports have indicated a poor prognosis. She was refractory to methylprednisolone pulse therapy and plasma exchange, but administration of cyclosporine induced remission without adverse effects. We propose that cyclosporine may be an effective treatment for cases of refractory TTP.
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Affiliation(s)
- Terukazu Enami
- Clinical Immunology, Advanced Biomedical Applications, Graduate School of Comprehensive Human Sciences, University of Tsukuba
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Majithia V, Harisdangkul V. Thrombotic thrombocytopenic purpura in systemic lupus erythematosus: A frequent and severe consequence of active disease. Rheumatology (Oxford) 2006; 45:1170-1. [PMID: 16837477 DOI: 10.1093/rheumatology/kel224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ogawa Y, Mukai M, Gotoh H, Tanaka S, Takada A, Takenouchi T. A case of thrombotic thrombocytopenic purpura with systemic lupus erythematosus. ACTA ACUST UNITED AC 2006; 29:342-7. [PMID: 17075194 DOI: 10.2177/jsci.29.342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We described a case of thrombotic thrombocytopenic purpura (TTP) with systemic lupus erythematosus (SLE). A-60-year old woman was admitted to our hospital because of fever, disconsciousness, and general fatigue. 32 years ago, she was diagnosed as SLE with Raynaud's phenomenon, rash, photosensitivity, arthritis, lymphocytopenia, and ANA. Her SLE was well controlled with 10 mg predonisolone as a maintance dose until several weeks ago. On admission, severe thrombocytopenia (0.7x10(4)/microl) and other laboratory data revealed microangiopathic hemolytic anemia and renal dysfunction, Immediately after diagnosed as TTP, plasma exchange and corticosteroid therapy started. In spite of the treatment, disconsciousness progressed and systemic convulsion occurred and died 4 days after admission. Autopsied examination revealed diffuse microvascular hyalinized thrombi in heart, kidney, liver, spleen, and pancreas. Some microvascular thrombi were detected in lymph nodes, bone marrow, intestine. Pathological diagnosis of TTP was made on microvascular hyalinized platelet thrombi in organs. Von Willebrand factor-cleaving protease (VWF-CP) activity in plasma on set is less than 0.5 percent of normal and inhibitor for VWF-CP was detected. We here report a valuable case for analysis of pathogenesis in SLE-TTP.
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Affiliation(s)
- Yayoi Ogawa
- Department of Pathology, Sapporo General City Hospital
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