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患者感染疟原虫 vivax 疟疾后发生获得性血栓性血小板减少性紫癜:病例报告。

Acquired thrombotic thrombocytopenic purpura in a patient with plasmodium vivax malaria: A case report.

机构信息

Facultad de Medicina de la Universidad Industrial de Santander, Bucaramanga, Santander, Colombia.

出版信息

Rev Soc Bras Med Trop. 2024 Sep 2;57:e008072024. doi: 10.1590/0037-8682-0014-2024. eCollection 2024.

Abstract

Acquired thrombotic thrombocytopenic purpura (TTP) is a rare life-threatening disorder characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ damage. We present the case of a 71-year-old man initially diagnosed with malaria-like symptoms and displaying markers of microangiopathic hemolytic anemia, severe thrombocytopenia, renal injury, and neurological impairment. Despite antimalarial treatment, acquired TTP was suspected. Plasma exchange and immunosuppressive therapy led to clinical improvement, normalizing the platelet count and hemolytic profile. Diagnostic confirmation revealed significantly reduced ADAMTS13 levels. Following the proposed treatment, the patient's ADAMTS13 levels normalized. This case illustrates acquired TTP linked to uncomplicated Plasmodium vivax malaria.

摘要

获得性血栓性血小板减少性紫癜(TTP)是一种罕见的危及生命的疾病,其特征为微血管病性溶血性贫血、严重血小板减少和器官损伤。我们报告了一例 71 岁男性,最初诊断为疟疾样症状,并表现出微血管病性溶血性贫血、严重血小板减少、肾损伤和神经功能障碍的标志物。尽管进行了抗疟治疗,但仍怀疑为获得性 TTP。血浆置换和免疫抑制治疗导致临床改善,血小板计数和溶血性特征正常化。诊断证实 ADAMTS13 水平显著降低。采用该治疗方案后,患者的 ADAMTS13 水平恢复正常。本病例说明获得性 TTP 与无并发症的间日疟原虫疟疾有关。

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本文引用的文献

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ISTH guidelines for the diagnosis of thrombotic thrombocytopenic purpura.ISTH 血栓性血小板减少性紫癜诊断指南。
J Thromb Haemost. 2020 Oct;18(10):2486-2495. doi: 10.1111/jth.15006. Epub 2020 Sep 11.
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Thrombotic Microangiopathy and the Kidney.血栓性微血管病与肾脏。
Clin J Am Soc Nephrol. 2018 Feb 7;13(2):300-317. doi: 10.2215/CJN.00620117. Epub 2017 Oct 17.
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Blood coagulation, inflammation, and malaria.血液凝固、炎症与疟疾。
Microcirculation. 2008 Feb;15(2):81-107. doi: 10.1080/10739680701451516.
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Hemostatic alterations in malaria.疟疾中的止血改变。
Southeast Asian J Trop Med Public Health. 1993;24 Suppl 1:86-91.

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