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A Rare Case of Thrombotic Thrombocytopenic Purpura (TTP) With Concurrent Renal Cell Carcinoma: Diagnostic and Therapeutic Challenges

Thrombotic thrombocytopenic purpura (TTP) is a potentially life-threatening thrombotic microangiopathy (TMA) that needs prompt identification and treatment. Disseminated malignancy-related TMA can potentially be misdiagnosed as TTP, and patients may be inappropriately subjected to therapeutic plasma...

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Autores principales: Bhandari, Amit, Pokhrel, Bidushi, Oli, Prakash R, Le, Quang, Basnet, Bibhusan, Freitag, Eric C, Nayani, Archana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290543/
https://www.ncbi.nlm.nih.gov/pubmed/37362465
http://dx.doi.org/10.7759/cureus.39494
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author Bhandari, Amit
Pokhrel, Bidushi
Oli, Prakash R
Le, Quang
Basnet, Bibhusan
Freitag, Eric C
Nayani, Archana
author_facet Bhandari, Amit
Pokhrel, Bidushi
Oli, Prakash R
Le, Quang
Basnet, Bibhusan
Freitag, Eric C
Nayani, Archana
author_sort Bhandari, Amit
collection PubMed
description Thrombotic thrombocytopenic purpura (TTP) is a potentially life-threatening thrombotic microangiopathy (TMA) that needs prompt identification and treatment. Disseminated malignancy-related TMA can potentially be misdiagnosed as TTP, and patients may be inappropriately subjected to therapeutic plasma exchange (TPE) with serious implications. Likewise, the presence of a concurrent cancer diagnosis in a patient with microangiopathic hemolytic anemia and thrombocytopenia may lead to suspicion of disseminated malignancy as the cause, delaying the TPE with serious outcomes. Testing for ADAMTS13 activity is diagnostic of TTP, but the results may take time. This poses a diagnostic and therapeutic dilemma that includes weighing the benefits of TPE for treating TTP and cancer treatment. We describe a rare case of immune-mediated TTP in a patient concurrently diagnosed with metastatic renal cell cancer. To our knowledge, this is the first case of TTP reported in patients with metastatic renal cell carcinoma (RCC) in a non-treatment-naive patient.
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spelling pubmed-102905432023-06-25 A Rare Case of Thrombotic Thrombocytopenic Purpura (TTP) With Concurrent Renal Cell Carcinoma: Diagnostic and Therapeutic Challenges Bhandari, Amit Pokhrel, Bidushi Oli, Prakash R Le, Quang Basnet, Bibhusan Freitag, Eric C Nayani, Archana Cureus Oncology Thrombotic thrombocytopenic purpura (TTP) is a potentially life-threatening thrombotic microangiopathy (TMA) that needs prompt identification and treatment. Disseminated malignancy-related TMA can potentially be misdiagnosed as TTP, and patients may be inappropriately subjected to therapeutic plasma exchange (TPE) with serious implications. Likewise, the presence of a concurrent cancer diagnosis in a patient with microangiopathic hemolytic anemia and thrombocytopenia may lead to suspicion of disseminated malignancy as the cause, delaying the TPE with serious outcomes. Testing for ADAMTS13 activity is diagnostic of TTP, but the results may take time. This poses a diagnostic and therapeutic dilemma that includes weighing the benefits of TPE for treating TTP and cancer treatment. We describe a rare case of immune-mediated TTP in a patient concurrently diagnosed with metastatic renal cell cancer. To our knowledge, this is the first case of TTP reported in patients with metastatic renal cell carcinoma (RCC) in a non-treatment-naive patient. Cureus 2023-05-25 /pmc/articles/PMC10290543/ /pubmed/37362465 http://dx.doi.org/10.7759/cureus.39494 Text en Copyright © 2023, Bhandari et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Oncology
Bhandari, Amit
Pokhrel, Bidushi
Oli, Prakash R
Le, Quang
Basnet, Bibhusan
Freitag, Eric C
Nayani, Archana
A Rare Case of Thrombotic Thrombocytopenic Purpura (TTP) With Concurrent Renal Cell Carcinoma: Diagnostic and Therapeutic Challenges
title A Rare Case of Thrombotic Thrombocytopenic Purpura (TTP) With Concurrent Renal Cell Carcinoma: Diagnostic and Therapeutic Challenges
title_full A Rare Case of Thrombotic Thrombocytopenic Purpura (TTP) With Concurrent Renal Cell Carcinoma: Diagnostic and Therapeutic Challenges
title_fullStr A Rare Case of Thrombotic Thrombocytopenic Purpura (TTP) With Concurrent Renal Cell Carcinoma: Diagnostic and Therapeutic Challenges
title_full_unstemmed A Rare Case of Thrombotic Thrombocytopenic Purpura (TTP) With Concurrent Renal Cell Carcinoma: Diagnostic and Therapeutic Challenges
title_short A Rare Case of Thrombotic Thrombocytopenic Purpura (TTP) With Concurrent Renal Cell Carcinoma: Diagnostic and Therapeutic Challenges
title_sort rare case of thrombotic thrombocytopenic purpura (ttp) with concurrent renal cell carcinoma: diagnostic and therapeutic challenges
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290543/
https://www.ncbi.nlm.nih.gov/pubmed/37362465
http://dx.doi.org/10.7759/cureus.39494
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