A case report of an unusual presentation of thrombotic thrombocytopenic purpura

Thrombotic thrombocytopenic purpura (TTP) is considered to be a rare cause of ischemic stroke (IS). A case of a newly diagnosed patient with acquired immune-mediated TTP (iTTP) is reported, in whom two IS events developed during 48 h. A 59-year-old diabetic male is presented to the hospital 24 h after symptoms onset, including left hemiparesis, dysarthria, and decreased consciousness. A brain CT scan is performed with the suspicion of acute IS, indicating infarct lesions in the right middle cerebral artery (MCA) territory. The patient is not eligible for thrombolytic therapy due to admission delay. Over the next 24 h, the patient’s neurological condition deteriorates, and the second brain CT scan shows new ischemic lesions. Initial laboratory evaluation indicates thrombocytopenia without evidence of anemia. However, in the following days, thrombocytopenia progresses, microangiopathic hemolytic anemia (MAHA) develops and the diagnosis of iTTP is confirmed. The patient undergoes plasma exchange, pulse IV methylprednisolone and Rituximab is also added due to the refractory course of the disease. After a prolonged hospital course, he has considerable neurologic recovery and is discharged. Thrombotic thrombocytopenic purpura should be considered in any patient presenting with IS and having thrombocytopenia or anemia without other symptoms of TTP. Read the full article here.