Multiple hemorrhagic infarcts in thrombotic thrombocytopenic purpura

摘要

A 57-year-old male presented with low-grade fever and upper abdominal pain for 2 months. He was known to have Type 2 diabetes mellitus, systemic hypertension, and ischemic heart disease. He had pallor, jaundice, and had no other signs. He had severe thrombocytopenia and features of microangiopathic hemolysis. A diagnosis of thrombotic thrombocytopenic purpura (TTP) due to clopidogrel was made excluding the other causes, and he was started on plasmapheresis. After a few cycles of plasmapheresis, he developed altered behavior. Magnetic resonance imaging (MRI) of brain revealed multiple regions of restricted diffusion in both cerebral hemispheres, with cortical laminar necrosis and microhemorrhages within most lesions; suggestive of hemorrhagic infarcts [Figure 1]. Plasmapheresis was continued, but despite all efforts he succumbed to his illness 2 days later.