The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Case Report

The Spectrum of Thrombotic Thrombocytopenic Purpura: A Clinicopathologic Demonstration of Tacrolimus-Induced Thrombotic Thrombocytopenic Purpura in a Lung Transplant Patient

Authors: Orson Go, MD, Asghar Naqvi, MD, Alvin Tan, MD, Ioana Amzuta, MD, Robert Lenox, MD

Abstract

Immunosuppressive drugs used post-transplantation are among the most common causes of thrombotic thrombocytopenic purpura (TTP). Diagnosis is often confounded not only by its myriad presentations, but also because these manifestations may be explained by the comorbidities or complications of transplantation. A 61-year-old female who had a single lung transplant for severe chronic obstructive pulmonary disease maintained on corticosteroids, tacrolimus and mycophenolate mofetil, was admitted for fever, headache with confusion and lethargy. She was mildly anemic and thrombocytopenic. Peripheral smear showed rare fragmented red cells. Muddy brown casts were present on urinalysis. She was diagnosed with TTP. Tacrolimus was discontinued and the mental status of the patient, anemia and thrombocytopenia improved significantly.


Key Points


* Thrombotic thrombocytopenic purpura is a clinical syndrome with myriad presentations.


* Diagnosis of this syndrome in transplant patients is often confounded by the comorbidities or complications of the transplantation.


* The syndrome is demonstrated to occur in lung transplant patients and as such, must always be thought of as a cause of progressive systemic symptoms in these populations.

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