Department of Hematology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie-Fang Avenue, Wuhan, Hubei, P.R. China.
Medicine (Baltimore). 2021 Nov 19;100(46):e27898. doi: 10.1097/MD.0000000000027898.
Thrombotic thrombocytopenic purpura (TTP) is a critical thrombotic microangiopathy involving multiple organs. To the best of our knowledge, there are no reports of TTP complicated by acute aortic dissection.
We herein described a 53-year-old male with TTP who did not have a significant medical history. After immediate plasma exchange and glucocorticoid therapy, the patient's clinical condition improved. However, the patient suddenly experienced chest pain with elevated blood pressure.
Computed tomography angiography suggested acute type B aortic dissection.
The patient was immediately transferred to the cardiac aortic surgery department for thoracic aortic endovascular repair.
The patient was discharged after successful thoracic aortic endovascular repair. Unfortunately, 3 months later, the patient experienced chest and back pain at home and died suddenly, possibly due to the recurrence of aortic dissection.
Even if patients have no identifiable risk factors, physicians should be aware of this rare and life-threatening acute complication of TTP, which may have multiple causes, including preexisting connective tissue disease, abnormal blood pressure fluctuations, and increased risk of hemorrhage. Early identification and timely treatment of acute aortic dissection are critical for improving prognosis.
血栓性血小板减少性紫癜（TTP）是一种涉及多个器官的严重血栓性微血管病。据我们所知，尚无 TTP 并发急性主动脉夹层的报道。
我们在此描述了一例 53 岁男性 TTP 患者，他没有明显的既往病史。在立即进行血浆置换和糖皮质激素治疗后，患者的临床状况有所改善。然而，患者突然出现胸痛伴血压升高。
计算机断层血管造影提示急性 B 型主动脉夹层。
患者立即被转至心脏主动脉外科进行胸主动脉腔内修复术。
患者成功接受胸主动脉腔内修复术后出院。不幸的是，3 个月后，患者在家中出现胸痛和背痛，并突然死亡，可能是由于主动脉夹层复发所致。
即使患者没有可识别的风险因素，医生也应该意识到 TTP 这种罕见且危及生命的急性并发症，其可能有多种病因，包括先前存在的结缔组织疾病、血压波动异常和出血风险增加等。早期识别和及时治疗急性主动脉夹层对于改善预后至关重要。
