A case of severe thrombotic thrombocytopenic purpura with concomitant legionella pneumonia: Review of pathogenesis and treatment

Tony Talebi, Gustavo Fernandez-Castro, Alberto J. Montero, Alexandra Stefanovic, Eric Lian

Research output: Contribution to journalReview article

4 Scopus citations

Abstract

Thrombotic thrombocytopenia purpura (TTP) is a severe multisystem disorder characterized by fever, microangiopathic hemolytic anemia, thrombocytopenia, neurologic symptoms, and impaired renal function. Platelet counts are usually diminished, whereas the bone marrow shows a large number of megakaryocytes indicating peripheral destruction and consumption of platelets. Coagulation studies in patients with TTP are normal or slightly elevated, which helps differentiate this entity from disseminated intravascular coagulation. The peripheral smear shows an abundance of schistocytes, reticulocytes, and, at times, nucleated red blood cells. Serum lactate dehydrogenase and indirect bilirubin are elevated as a result of mechanical destruction of red blood cells. Legionella pneumophila has been identified as a relatively common cause of both community-acquired and hospital-acquired pneumonia. An association between Legionella and TTP has only been cited once in the literature. Here we present a case of severe TTP with concurrent Legionella infection. Our patient presented with the classic clinical findings of TTP and an ADAMTS13 level of less than 5% associated with an inhibitor. After a 3-week treatment course with plasma exchange, steroids, and antibiotics, he had complete clinical recovery and his ADAMTS13 level increased to greater than 75%.

Original languageEnglish (US)
Pages (from-to)e180-e185
JournalAmerican journal of therapeutics
Volume18
Issue number5
DOIs
StatePublished - Sep 1 2011

Keywords

  • ADAMTS13
  • cryosupernant plasma
  • hemolytic uremic syndrome
  • legionella
  • plasma exchange
  • thrombocytopenia
  • thrombotic thrombocytopenic purpura

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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