Douglass Megan B, Yessin Olivia, Elengickal Joseph, Charpenter Sheldon, Campbell Cayla
Internal Medicine, Prisma Health Richland Hospital, Columbia, USA.
Cureus. 2024 Jun 2;16(6):e61536. doi: 10.7759/cureus.61536. eCollection 2024 Jun.
Synthetic cannabinoids (SCs) have become commercially available throughout the United States as manufacturers circumvent regulations with labels stating "not for human consumption" with misleading advertisements, resulting in the consumption of products that are not safe or regulated. We present a case report of a middle-aged woman exhibiting altered mental status secondary to SC use who was found to have severe thrombocytopenia and hemolytic anemia. She was later confirmed to have thrombotic thrombocytopenic purpura (TTP) through ADAMTS13 testing. TTP is one of several platelet-related disorders presenting with findings of hemolytic anemia and thrombocytopenia. The presence of altered mental status is typically used as a symptomatic differentiator between hemolytic uremic syndrome, immune thrombocytopenic purpura, and TTP. SCs can cause superimposed altered mental status, which, in the setting of a concomitant platelet disorder, can complicate the standard workup and prolong the time to a final diagnosis. This case serves as an essential reminder that collecting detailed social history and promptly recognizing laboratory abnormalities is critical for early recognition of TTP, as the diagnosis is time-sensitive and delays in recognition can lead to significant morbidity and mortality.
合成大麻素（SCs）已在美国各地广泛上市，制造商通过带有“非供人类食用”标签的误导性广告规避监管，导致人们消费不安全或不受监管的产品。我们报告一例中年女性因使用合成大麻素出现精神状态改变的病例，该患者被发现患有严重血小板减少症和溶血性贫血。通过ADAMTS13检测，她后来被确诊为血栓性血小板减少性紫癜（TTP）。TTP是几种与血小板相关的疾病之一，表现为溶血性贫血和血小板减少。精神状态改变通常被用作溶血性尿毒症综合征、免疫性血小板减少性紫癜和TTP之间的症状鉴别点。合成大麻素可导致叠加的精神状态改变，在伴有血小板疾病的情况下，这会使标准检查复杂化，并延长最终诊断的时间。该病例有力地提醒我们，收集详细的社会史并及时识别实验室异常对于早期识别TTP至关重要，因为诊断具有时间敏感性，识别延迟可能导致严重的发病率和死亡率。
