DOI: 10.36347/sjmcr.2017.v05i10.012

Pages: 642-645

A 43-year-old female had experienced general fatigue for 1 month. 　For two weeks, she was admitted for dehydration to a local medical facility and she developed a fever, oligouria, and abdominal pain treated by antibiotics without a culture examination. However, her circulation became unstable, so she was transferred to another hospital. There, she was diagnosed with septic shock and renal failure, liver dysfunction, anemia, and thrombocytopenia and was immediately transported again to our hospital the same day. Upon arrival, after tracheal intubation, computed tomography for detecting septic focus failed to reveal the origin. A peripheral blood smear showed microangiopathic hemolytic anemia with schistocytes and thrombocyto¬penia. She received a diagnosis of thrombotic microangiopathy (TMA)—specifically, thrombotic thrombocytopenic purpura. After admission to the intensive-care unit, she underwent infusion of vasopressors, antibiotics, gamma globulin and steroid for sepsis, continuous hemodiafiltration for acute renal failure, plasma exchange, and mechanical ventilation. After these treatments, her unstable circulation and respiratory and renal dysfunction gradually improved. Thrombocytopenia worsened to 7,000 μl on the fifth hospital day but increased gradually. Mechanical ventilation and the use of vasopressors were diminished following renal replacement therapy. All tests to detect the focus of the infection were negative except for positive findings of procalcitonin and beta-D glucan. ADAMTS13 and ADAMTS13 inhibitor were negative. She additionally received anti-fungal drug and platelet transfusion. After medical treatment and rehabilitation, she was discharged on Day 36 of hospitalization. We herein report a rare case of TMA suspected of being induced by bacterial infection. Physicians should perform a culture study before the administration of antibiotics.