Vigilanzminderung, akutes Nierenversagen und Thrombozytopenie bei einem Patienten mit Leberzirrhose – eine seltene Differentialdiagnose

摘要

We report the case of a 45-year-old male who was admitted to the intensive care unit with impaired consciousness and acute renal failure after liver transplantation because of cirrhosis of the liver due to hepatitis C and a complex course of disease after transplantation including recurrence of cirrhosis. After exclusion of cerebral lesions, the patient underwent hemofiltration assuming a drug-induced renal failure, leading to a reduction of the retention parameters. During the course of treatment, progressive thrombocytopenia occurred. Differential diagnoses were heparin-induced thrombocytopenia, bone marrow depression after treatment with linezolid due to the detection of E. faecium, recurrence of cirrhosis after liver transplantation owing to the reactivation of hepatitis C, thrombocytopenia in the context of a coexistent HIV infection, or pseudothrombocytopenia. In the lab tests, hemolytic anemia with raised levels of LDH and detection of fragmentocytes in the manual blood count were the factors establishing the diagnosis of a secondary, transplantation-associated thrombotic thrombocytopenic purpura (TTP) as a result of immunosuppressive therapy with cyclosporine. The patient underwent multiple sessions of plasma separation, which resulted in raised platelet levels and clinical signs of recovery.