Systemic Lupus Erythematosus (SLE) and Thrombotic Thrombocytopenic Purpura (TTP) Presenting as Recurrent Strokes: A Case Report

Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially life-threatening condition characterized by fever, acute hemolysis, thrombocytopenia, renal dysfunction, and CNS dysfunction. A peripheral smear shows schistocytes because of microangiopathy. It is extremely rare for TTP and systemi...

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Published inCurēus (Palo Alto, CA) Vol. 16; no. 5; p. e60238
Main Authors Kadam, Abhinav, Toshniwal, Saket, Acharya, Sourya, Shukla, Samarth
Format Journal Article
LanguageEnglish
Published United States Cureus Inc 13.05.2024
Cureus
Subjects
Abdomen
Blood
Blood platelets
Case reports
Coma
Creatinine
Fever
Hematology
Hemoglobin
Internal Medicine
Lupus
Magnetic resonance imaging
Nervous system
Neurology
Patients
Proteins
Purpura
Rheumatology
Thrombocytopenia
Ultrasonic imaging
Urine
nephrotic
thrombocytopenia
plasmapheresis
proteinuria
anemia
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Summary:Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially life-threatening condition characterized by fever, acute hemolysis, thrombocytopenia, renal dysfunction, and CNS dysfunction. A peripheral smear shows schistocytes because of microangiopathy. It is extremely rare for TTP and systemic lupus erythematosus (SLE) to coexist. This report details an Indian female patient's uncommon clinical presentation of TTP linked to SLE. A 52-year-old woman presented to the emergency department with complaints of altered sensorium and weakness of the right side of the body. She was initially evaluated as a case of a cerebrovascular accident. CT brain imaging revealed multiple ischemic infarcts involving both cerebral hemispheres. MRI brain confirmed the same. During further evaluation, she was found to have hemolytic anemia, thrombocytopenia, and nephrotic range proteinuria. Immunological investigations confirmed SLE. A peripheral smear revealed schistocytes, and the PLASMIC score confirmed a high risk of TTP. The patient was treated with immunosuppressants, plasma exchange, and hemodialysis, along with other supportive measures. The patient showed a positive response to the therapy mentioned, with improved power and renal function. The patient denied a renal biopsy and was discharged after two weeks. This case report emphasizes the importance of the association between TTP and SLE.
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ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.60238