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Case report
Pneumococcal induced thrombotic thrombocytopenic purpura with features of purpura fulminans
  1. Laura Frances Walsh1,
  2. Jacqueline E Sherbuk2 and
  3. Brian Wispelwey2
  1. 1Internal Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
  2. 2Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
  1. Correspondence to Laura Frances Walsh; lfw4z{at}virginia.edu

Abstract

A 42-year-old woman with a history of acute myeloid leukaemia status postallogeneic stem cell transplant presented with fevers, altered mental status, pulmonary infiltrates and septic shock that further progressed to thrombocytopenia and purpura fulminans. Laboratory studies were consistent with a diagnosis of thrombotic thrombocytopenic purpura (TTP). Blood cultures grew Streptococcus pneumoniae. On chart review, our patient had a history of low immunoglobulin levels following stem cell transplant, which may have predisposed her to pneumococcal infection. The patient responded to therapy with ceftriaxone, plasma exchange, rituximab and caplacizumab. This is the fourth-documented case of pneumococcal induced TTP and, to the best of our knowledge, the first-describing pneumococcal induced TTP with purpura fulminans. We conclude that patients with TTP should be evaluated for infectious aetiologies and empiric antibiotics should be considered. Clinicians should be aware of the possibility for TTP to lead to purpura fulminans.

  • infections
  • malignant disease and immunosuppression
  • immunology
  • thrombotic thrombocytopenic purpura
  • purpura fulminans

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Footnotes

  • Contributors LFW: compiled case materials and wrote initial draft of the report. JES: compiled case materials and provided extensive editing to the final draft. BW: oversaw patient care, guided development of concepts written in the report and edited the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.