The Need for Primary Care Beyond the Postnatal Period: Uncontrolled Hypertension-Induced Thrombotic Microangiopathy in a 32-Year-Old With a History of Preeclampsia Presenting Three Months Postpartum

A 32-year-old African American female with a past medical history of uncontrolled hypertension and preeclampsia with severe features presented to the emergency department with three days of shortness of breath, chest pain, bloody cough, and non-bloody diarrhea without any known prior viral syndrome. On presentation, she was diagnosed with a hypertensive emergency with renal and cardiac dysfunction. Laboratory workup revealed leukocytosis, normocytic anemia, and thrombocytopenia. The remainder of the laboratory data were significant for hemolysis. Differential diagnosis included thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS); therefore, the patient was initiated on TTP treatment of pulsed dose steroids and plasma exchange. However, once the ADAMTS13 test returned negative, plasma exchange was stopped and the patient’s profile returned to normal with supportive care and aggressive blood pressure control, as she had hypertension-induced thrombotic microangiopathy.