Omole Adekunle E, Ali Azka, Ogunniyi Kayode E, Waqar Danish, Tobalesi Opeyemi, Rahim Omar, Awosika Ayoola
Anatomical Sciences, American University of Antigua, College of Medicine, Saint John, ATG.
Internal Medicine, Chicago Medical School/Rosalind Franklin University of Medicine and Sciences, North Chicago, USA.
Cureus. 2023 Mar 12;15(3):e36039. doi: 10.7759/cureus.36039. eCollection 2023 Mar.
Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially devastating blood disorder depicted by thrombocytopenia, fever, widespread small vessel hemolytic anemia, and neurological symptoms. The involvement of the renal and neurological systems is frequently reported in TTP; however, TTP-induced acute coronary syndrome is not widely reported. We describe a case of myocardial infarction induced by TTP in a patient who presented with the typical manifestation of acute coronary syndrome. Echocardiogram revealed a myocardial injury, and detailed investigations revealed increased levels of troponin I, lactate dehydrogenase, diminished levels of haptoglobin and von Willebrand factor-cleaving protease, and schistocytes on peripheral smear, suggestive of TTP-induced myocardial infarction. His condition was stabilized after commencing plasmapheresis, steroids, and rituximab. The initial steps in the management of this patient involve the prompt administration of steroids and the urgent start of plasmapheresis to increase platelet count.
血栓性血小板减少性紫癜（TTP）是一种罕见且可能具有毁灭性的血液疾病，其特征为血小板减少、发热、广泛的小血管溶血性贫血和神经症状。TTP患者常累及肾脏和神经系统；然而，TTP诱发的急性冠状动脉综合征报道并不广泛。我们描述了一例TTP诱发心肌梗死的病例，该患者表现为典型的急性冠状动脉综合征。超声心动图显示心肌损伤，详细检查发现肌钙蛋白I、乳酸脱氢酶水平升高，触珠蛋白和血管性血友病因子裂解蛋白酶水平降低，外周血涂片可见裂红细胞，提示TTP诱发心肌梗死。开始血浆置换、使用类固醇和利妥昔单抗治疗后，他的病情得到稳定。该患者治疗的初始步骤包括迅速给予类固醇并紧急开始血浆置换以增加血小板计数。
