PT  - JOURNAL ARTICLE
AU  - Kevin Singh
AU  - Ahmed Jamal Nadeem
AU  - Behzad Doratotaj
TI  - A rare case of thrombotic microangiopathy triggered by acute pancreatitis
AID  - 10.1136/bcr-2016-218581
DP  - 2017 May 15
TA  - BMJ Case Reports
PG  - bcr-2016-218581
VI  - 2017
4099  - http://casereports.bmj.com/content/2017/bcr-2016-218581.short
4100  - http://casereports.bmj.com/content/2017/bcr-2016-218581.full
AB  - Thrombotic microangiopathy (TMA) occurring after acute pancreatitis is rarely described. Without prompt intervention, TMA can be, and often is, lethal, so prompt recognition is important. Here, we present a case of a 61-year-old woman with a history of alcohol misuse who presented with epigastric pain, nausea and vomiting after binge drinking. Elevated serum lipase and imaging were suggestive of acute-on-chronic pancreatitis. Although the patient’s symptoms of acute pancreatitis subsided, her anaemia, thrombocytopenia and acute kidney injury worsened. A peripheral blood smear revealed schistocytes, prompting suspicion for TMA. Therapeutic plasma exchange (TPE) was promptly initiated and she completed 10 TPE sessions that improved her anaemia and serum creatinine and resolved the thrombocytopenia. Since TPE was effective and the ADAMTS13 assay revealed 55% activity in the absence of anti-ADAMTS13 IgG prior to initiation of therapy, a confident diagnosis of TMA caused by acute pancreatitis was made. There was no evidence of relapse 2 years later.