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Thrombotic thrombocytopenic purpura and hemophagocytic lymphohistiocytosis in an elderly man: A case report

RATIONALE: Thrombotic thrombocytopenic purpura (TTP) and hemophagocytic lymphohistiocytosis (HLH) are rare hematologic conditions and have high mortality. Both TTP and HLH result from deregulation of the immune system. There are no published reports of coexisting TTP and HLH in elderly patients. PAT...

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Autores principales: Aiempanakit, Kumpol, Apinantriyo, Benjawan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221720/
https://www.ncbi.nlm.nih.gov/pubmed/30383662
http://dx.doi.org/10.1097/MD.0000000000013025
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author Aiempanakit, Kumpol
Apinantriyo, Benjawan
author_facet Aiempanakit, Kumpol
Apinantriyo, Benjawan
author_sort Aiempanakit, Kumpol
collection PubMed
description RATIONALE: Thrombotic thrombocytopenic purpura (TTP) and hemophagocytic lymphohistiocytosis (HLH) are rare hematologic conditions and have high mortality. Both TTP and HLH result from deregulation of the immune system. There are no published reports of coexisting TTP and HLH in elderly patients. PATIENT CONCERNS: A 67-year-old Asian male presented with altered consciousness and fever for 2 days. Physical examination revealed markedly pale, mild icterus with petechiae and purpura. Initially, TTP was recognized in this patient. Bone marrow studies are suggested for evaluating elderly patients to assess specific causes, especially infection and neoplasm. DIAGNOSES: The TTP was diagnosed based on typical history-related symptoms and a specific laboratory result of very low ADAMTS13 level. The diagnosis of HLH was determined after detection of high levels of ferritin and lactase dehydrogenase, which were confirmed by the presence of hemophagocytosis in the bone marrow. INTERVENTIONS: Systemic corticosteroids and plasma exchange were initiated as specific treatment of the patient. OUTCOMES: The patient died in 3 weeks from ventilator-associated pneumonia. LESSONS: The HLH should be tested using bone marrow studies and specific laboratory tests in patients with TTP.
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spelling pubmed-62217202018-12-04 Thrombotic thrombocytopenic purpura and hemophagocytic lymphohistiocytosis in an elderly man: A case report Aiempanakit, Kumpol Apinantriyo, Benjawan Medicine (Baltimore) Research Article RATIONALE: Thrombotic thrombocytopenic purpura (TTP) and hemophagocytic lymphohistiocytosis (HLH) are rare hematologic conditions and have high mortality. Both TTP and HLH result from deregulation of the immune system. There are no published reports of coexisting TTP and HLH in elderly patients. PATIENT CONCERNS: A 67-year-old Asian male presented with altered consciousness and fever for 2 days. Physical examination revealed markedly pale, mild icterus with petechiae and purpura. Initially, TTP was recognized in this patient. Bone marrow studies are suggested for evaluating elderly patients to assess specific causes, especially infection and neoplasm. DIAGNOSES: The TTP was diagnosed based on typical history-related symptoms and a specific laboratory result of very low ADAMTS13 level. The diagnosis of HLH was determined after detection of high levels of ferritin and lactase dehydrogenase, which were confirmed by the presence of hemophagocytosis in the bone marrow. INTERVENTIONS: Systemic corticosteroids and plasma exchange were initiated as specific treatment of the patient. OUTCOMES: The patient died in 3 weeks from ventilator-associated pneumonia. LESSONS: The HLH should be tested using bone marrow studies and specific laboratory tests in patients with TTP. Wolters Kluwer Health 2018-11-02 /pmc/articles/PMC6221720/ /pubmed/30383662 http://dx.doi.org/10.1097/MD.0000000000013025 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle Research Article
Aiempanakit, Kumpol
Apinantriyo, Benjawan
Thrombotic thrombocytopenic purpura and hemophagocytic lymphohistiocytosis in an elderly man: A case report
title Thrombotic thrombocytopenic purpura and hemophagocytic lymphohistiocytosis in an elderly man: A case report
title_full Thrombotic thrombocytopenic purpura and hemophagocytic lymphohistiocytosis in an elderly man: A case report
title_fullStr Thrombotic thrombocytopenic purpura and hemophagocytic lymphohistiocytosis in an elderly man: A case report
title_full_unstemmed Thrombotic thrombocytopenic purpura and hemophagocytic lymphohistiocytosis in an elderly man: A case report
title_short Thrombotic thrombocytopenic purpura and hemophagocytic lymphohistiocytosis in an elderly man: A case report
title_sort thrombotic thrombocytopenic purpura and hemophagocytic lymphohistiocytosis in an elderly man: a case report
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221720/
https://www.ncbi.nlm.nih.gov/pubmed/30383662
http://dx.doi.org/10.1097/MD.0000000000013025
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