Differentiating between severe hypertension and thrombocytopenic purpura as the cause of thrombotic microangiopathy in a patient with Castleman disease: a case report and literature review.

Autor: Feldman I; Intermediate Care Department, Bait Balev Hospital, Rishon LeZion, Israel., Shapiro DS; Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel.; Division of Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.; Hadassah Hebrew University School of Medicine, Jerusalem Israel., Ellis R; Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel.; Division of Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel., Friedman R; Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel.; Division of Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.; Hadassah Hebrew University School of Medicine, Jerusalem Israel.
Jazyk: angličtina
Zdroj: Oxford medical case reports [Oxf Med Case Reports] 2023 Jun 26; Vol. 2023 (6), pp. omad059. Date of Electronic Publication: 2023 Jun 26 (Print Publication: 2023).
DOI: 10.1093/omcr/omad059
Abstrakt: Thrombotic microangiopathy (TMA) is a syndrome characterized by thrombosis in capillaries and arterioles, resulting in microangiopathic hemolytic anemia, thrombocytopenia and target organ injury. In TMA presenting with severe hypertension, it is difficult to determine whether the TMA is primary and due to thrombotic thrombocytopenic purpura (TTP) or secondary to severe hypertension. The response to antihypertensive medication favors the diagnosis of severe hypertension as the cause of TMA. Comorbid inflammatory disease supports the diagnosis of TTP-induced TMA. This case describes a 75-year-old woman with Castleman disease who presented with severe hypertension and TMA. She improved with hypertension therapy. However, ADAMST13 showed zero activity, and the diagnosis was TTP. In cases of TMA accompanied by severe hypertension, it is challenging to diagnose the cause of TMA. Even when there is a pronounced clinical response to lowering blood pressure, the diagnosis of TTP should be considered, particularly when an inflammatory disease is present.
Competing Interests: None declared.
(© The Author(s) 2023. Published by Oxford University Press.)
Databáze: MEDLINE
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