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一个罕见的交集:在登革热背景下管理血栓性血小板减少性紫癜

A Rare Intersection: Managing Thrombotic Thrombocytopenic Purpura in the Context of Dengue Fever.

作者信息

Haj Mohamad Hamza, Toubah Abduljaleel M, Audi Fatima, Nouh Abdelrahman, Jaber Abdallah, Hashimi Obaid, Shaheen Mahasin

机构信息

Internal Medicine, Al Qassimi Hospital, Sharjah, ARE.

出版信息

Cureus. 2024 Sep 6;16(9):e68818. doi: 10.7759/cureus.68818. eCollection 2024 Sep.

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening condition that can lead to severe morbidity and mortality if untreated. This case report discusses a 31-year-old male with dengue fever who developed TTP, resulting in fatality despite timely diagnosis and comprehensive treatment. The patient presented with worsening symptoms, including body aches, gastrointestinal bleeding, and neurological issues. Initial treatment focused on managing dengue hemorrhagic fever, but TTP was later suspected, leading to the cessation of platelet transfusions and initiation of plasma exchange, steroids, and rituximab. Despite these efforts, the patient's condition deteriorated. This case underscores the challenges in managing TTP, especially when triggered by infections like dengue. The use of the PLASMIC score can be highly effective in suspecting TTP in these patients, allowing for the initiation of early management. While standard treatments include plasma exchange and immunosuppressive therapy, emerging treatments such as caplacizumab and the potential use of splenectomy may offer hope for better outcomes in the future.

摘要

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,如果不治疗,可导致严重的发病率和死亡率。本病例报告讨论了一名31岁患登革热的男性,他发展为TTP,尽管及时诊断和综合治疗仍导致死亡。患者出现症状加重,包括身体疼痛、胃肠道出血和神经问题。初始治疗重点是管理登革出血热,但后来怀疑是TTP,导致停止血小板输注并开始进行血浆置换、使用类固醇和利妥昔单抗。尽管采取了这些措施,患者的病情仍恶化。本病例强调了管理TTP的挑战,尤其是当由登革热等感染引发时。使用PLASMIC评分在怀疑这些患者患有TTP时非常有效,可允许早期开始管理。虽然标准治疗包括血浆置换和免疫抑制治疗,但诸如卡泊单抗等新兴治疗方法以及脾切除术的潜在应用可能为未来更好的治疗结果带来希望。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/de56/11456337/a5cb48a75df2/cureus-0016-00000068818-i01.jpg

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