Sherer David M, Sanmugarajah Jasotha, Dalloul Mudar, Temkin Sarah M, Thanus John, Abulafia Ovadia
Divisions of Maternal-Fetal Medicine and Gynecologic Oncology, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
Am J Perinatol. 2005 May;22(4):223-5. doi: 10.1055/s-2005-866605.
An increased incidence of thrombotic thrombocytopenic purpura has been reported among human immunodeficiency virus-infected patients or those with acquired immunodeficiency syndrome (AIDS). Despite this association, hitherto only a single case of thrombotic thrombocytopenic purpura has been reported in an HIV-infected patient during pregnancy. We describe a young multiparous patient with long-standing AIDS who presented with lower abdominal pain. Following findings of thrombocytopenia, microangiopathic hemolytic anemia, renal failure, low-grade fever, and mental status changes, thrombotic thrombocytopenic purpura was diagnosed after initially considering the diagnosis of severe preeclampsia, and the patient was delivered by cesarean section. The patient required multiple plasma exchanges during a protracted postpartum course, and was discharged in good health. This first report of thrombotic thrombocytopenic purpura and AIDS in pregnancy demonstrates that when encountering preeclampsia in patients with AIDS, thrombotic microangiopathy should be strongly considered. In addition, these patients may exhibit an attenuated response to plasma exchange therapy and despite previous reports in nonobstetric patients, a favorable outcome is attainable in these critically ill patients.
据报道，在人类免疫缺陷病毒（HIV）感染患者或获得性免疫缺陷综合征（AIDS）患者中，血栓性血小板减少性紫癜的发病率有所增加。尽管存在这种关联，但迄今为止，仅报告过1例HIV感染患者在孕期发生血栓性血小板减少性紫癜。我们描述了1例患有长期AIDS的经产妇，她出现了下腹部疼痛。在发现血小板减少、微血管病性溶血性贫血、肾衰竭、低热和精神状态改变后，最初考虑为重度子痫前期，最终诊断为血栓性血小板减少性紫癜，并通过剖宫产分娩。该患者在产后病程迁延期间需要多次进行血浆置换，最终健康出院。这例孕期血栓性血小板减少性紫癜合并AIDS的首例报告表明，在AIDS患者中遇到子痫前期时，应高度怀疑血栓性微血管病。此外，这些患者对血浆置换治疗的反应可能减弱，尽管之前在非产科患者中有相关报道，但这些重症患者仍可获得良好结局。
