Thrombotic Thrombocytopenic Purpura Masked by Severe Preeclampsia: A Case Report.

Thrombotic thrombocytopenic purpura (TTP) is an exceptionally rare complication during pregnancy and even rarer when it coincides with severe preeclampsia in the same index pregnancy. We report the case of a 36-year-old female who presented with confusion at 38 weeks of gestation. Although her signs and symptoms strongly suggested severe preeclampsia, she was expected to make a full recovery after an emergency C-section. However, her failure to recover and persistent deterioration indicated the need for further investigations into the cause. Once her blood smear showed fragmented cells, plasma exchange treatment was initiated immediately without waiting for the results of the ADAMST13 activity test, which later showed almost undetectable levels. Ultimately, the patient achieved a full recovery, and her platelet count as well as ADAMST13 levels continued to improve upon 12 weeks of follow-up with no further treatment needed. Proper clinical judgment and a cooperative multidisciplinary team were key elements in managing this case.