DOI: 10.36347/sjmcr.2016.v04i10.023

Pages: 777-781

A 45-year-old female felt general fatigue over a 7-day period during the summer. For 5 days, she had skin lesions and a fever over 38 °C, so she visited a local clinic. She received a prescription of Loxoprofen and Teprenone due to suspicion of a viral infection. However, her symptoms did not improve, so she visited the same clinic again. Given that she had hypotension, and hypoxia, she was transported to our hospital. Upon arrival, she had swollen lymph nodes on her neck, and multiple scattered spotty erythema over her whole body. A peripheral blood smear showed microangiopathic hemolytic anemia with schistocytes and thrombocyto¬penia. She was treated with massive infusion of Ringer’s lactate and noradrenaline for hypotension; however, her unstable circulation did not improve. In addition, her consciousness became restless, so she was intubated in the emergency room. After admission to the intensive-care unit, she underwent infusion of levofloxacin, minocycline, gamma globulin, glycyrrhizinate for sepsis, thrombomodulin for disseminated intravascular coagulopathy, steroids for septic shock, continuous hemodiafiltration for acute renal failure, and mechanical ventilation for acute respiratory distress syndrome. After these treatments, her unstable circulation and respiratory and renal dysfunction gradually improved. After medical treatment and rehabilitation, she was discharged on Day 20 of hospitalization. The present patient had the “classic pentad” of TTP clinically. Approximately 20% to 50% of patients with TTP experience a relapse. Accordingly, the patient is being followed as an outpatient under careful monitoring.