Chronic relapsing thrombotic thrombocytopenic purpura.

A 58-year-old man had anemia and thrombocytopenia immediately after a myocardial infarction; recovery occurred spontaneously, but relapses followed intercurrent infection and abdominal surgery. The terminal relapse was precipitated by gastric ulcer with hemorrhagic gastritis; this episode was characterized by fluctuating neurologic symptoms including coma. Autopsy studies confirmed the diagnosis of thrombotic thrombocytopenic purpura. This case shows that thrombotic thrombocytopenic purpura may occur de novo in adults as a relapsing syndrome with exacerbations precipitated by diverse events characterized by inflammation or tissue necrosis.