Thrombotic thrombocytopenic purpura following a cutaneous herpes zoster infection in a Thai female: Case report

Abstract

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a rare but fatal disease. Clinical presentations are nonspecific and usually require a skilled physician to detect. Rapid diagnosis and treatment is imperative in clinical practice.

Objective: To report a case of thrombotic thrombocytopenic purpura in a patient with end stage renal disease.

Methods: Retrospective study that presented the patient’s history, physical examinations, laboratory investigations, imaging, clinical course and treatment. The data is derived from the hospital medical records.

Results: A 72-year-old Thai female with end stage renal disease on regular hemodialysis, presented with alteration of consciousness and microangiopathic hemolytic anemia. Recent history of herpes zoster skin infection raised a clinical suspicion for herpes meningoencephalitis. However, after adequate treatment, her symptoms deteriorated. Hematology was consulted and a provisional diagnosis of thrombotic thrombocytopenic purpura was made. Plasma exchange was initiated and the patient’s clinical improved after five cycles of plasma exchange with adjunctive corticosteroids. Immunosuppression was prolonged due to refractoriness of TTP. An occult infection of abdominal tuberculosis was later identified as a potential TTP trigger
and treated.

Conclusion: A case study of Thrombotic thrombocytopenic purpura following a herpes zoster infection. Recognizing the condition facilitates appropriate diagnostic testing and early treatment, thereby helping to reduce patient mortality.