Senanayake H M, Patabendige M
Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
University Obstetrics Unit, De Soysa Hospital for Women, Colombo, Sri Lanka.
J Med Case Rep. 2018 Jun 6;12(1):158. doi: 10.1186/s13256-018-1701-4.
Thrombotic thrombocytopenic purpura and peripartum cardiomyopathy are potentially lethal complications of pregnancy. We describe a case in which both of these developed in the same patient. The etiologies of both conditions remain uncertain, but they share immune hyperreactivity as a possible cause.
A 33-year-old Lankan primigravida gave birth at 38 weeks of gestation by cesarean section when she presented with right-sided abdominal pain and a provisional diagnosis of appendicitis. Her pain persisted postoperatively, and on the second postoperative day, she physicaly collapsed suddenly with abdominal distention. Immediate laparotomy revealed generalized oozing from the peritoneum resulting in hemoperitoneum and intestinal hemorrhage. Her laboratory reports showed microangiopathic hemolytic anemia and thrombocytopenia. She also had elevated liver enzyme, lactate dehydrogenase, and creatinine concentrations. A diagnosis of thrombotic thrombocytopenic purpura was made. After a steady recovery, she was discharged from the hospital on the 16th postoperative day, but 12 hours later, she was readmitted with acute-onset progressively worsening shortness of breath. Echocardiography confirmed peripartum cardiomyopathy. She was treated with a bromocriptine and heart failure regimen. At 6 weeks postpartum, her laboratory test results and cardiac function had improved.
A possible autoimmune association might have caused both conditions in our patient. This case report serves as a warning message that pregnant women with one possible condition with autoimmune association could go on to develop other similar conditions.
血栓性血小板减少性紫癜和围产期心肌病是妊娠潜在的致命并发症。我们描述了一例这两种疾病在同一患者身上同时发生的病例。这两种疾病的病因仍不明确，但它们都可能与免疫反应过度有关。
一名33岁的斯里兰卡初产妇，妊娠38周时因右侧腹痛行剖宫产分娩，当时初步诊断为阑尾炎。术后她的疼痛持续存在，术后第二天，她突然身体虚脱并伴有腹胀。立即剖腹探查发现腹膜广泛渗血，导致腹腔积血和肠道出血。她的实验室报告显示微血管病性溶血性贫血和血小板减少。她的肝酶、乳酸脱氢酶和肌酐浓度也升高。诊断为血栓性血小板减少性紫癜。病情稳定好转后，她于术后第16天出院，但12小时后，因急性起病且进行性加重的气短再次入院。超声心动图确诊为围产期心肌病。她接受了溴隐亭和心力衰竭治疗方案。产后6周时，她的实验室检查结果和心功能有所改善。
我们的患者可能因自身免疫相关因素导致了这两种疾病。本病例报告警示，患有一种可能与自身免疫相关疾病的孕妇可能会继而发生其他类似疾病。
