Association of Appendicitis, Helicobacter Pylori Positive Gastritis and Thrombotic Thrombocytopenic Purpura in an Adolescent
Autor: | Josipa Radić, Sandra Prgomet, Marijan Saraga, Tanja Kovačević, Zoltán Prohászka, Eugenija Marušić, Adela Arapović, Ranka Despot |
---|---|
Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
Male
medicine.medical_specialty Adolescent Thrombotic thrombocytopenic purpura ADAMTS13 Protein 030204 cardiovascular system & hematology Gastroenterology Helicobacter Infections 03 medical and health sciences 0302 clinical medicine Melena hemic and lymphatic diseases Internal medicine medicine Humans Purpura Autoantibodies Thrombotic Thrombocytopenic Purpura Thrombotic Thrombocytopenic biology business.industry BIOMEDICINE AND HEALTHCARE. Basic Medical Sciences Articles General Medicine Microangiopathic hemolytic anemia Helicobacter pylori Appendicitis biology.organism_classification medicine.disease ADAMTS13 Helicobacter Pylori Platelet transfusion Gastritis 030220 oncology & carcinogenesis Fresh frozen plasma medicine.symptom BIOMEDICINA I ZDRAVSTVO. Temeljne medicinske znanosti business |
Zdroj: | The American Journal of Case Reports American Journal of Case Reports Volume 20 |
ISSN: | 1941-5923 |
Popis: | Patient: Male, 16 Final Diagnosis: Thrombotic thrombocytopenic purpura Symptoms: Anemia Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology Objective: Unusual clinical course Background: Thrombotic thrombocytopenic purpura (TTP) in children is a rare life-threatening syndrome, characterized by microangiopathic hemolytic anemia, thrombocytopenia with renal dysfunction, neurologic symptoms, and fever. TTP is usually caused by deficient activity of von Willebrand factor cleaving protease (ADAMTS13), due to either gene mutations or acquired via anti-ADAMTS13 autoantibodies. It can be triggered by bone marrow or solid organ transplantation, cardiothoracic-, abdominal-, and orthopedic surgeries, infections including very rarely Helicobacter pylori infection. Case Report: Here we report a case of a 16-year-old male with TTP, who presented with thrombocytopenia before an appendectomy. Seven days after surgery, our patient started to vomit, developed melena, and was admitted to our pediatric intensive care unit (PICU) with clinical presentation of shock. Gastroscopy revealed H. pylori positive hemorrhagic gastritis. The patient was treated by erythrocyte transfusions, fresh frozen plasma, human albumin, glucose-electrolyte solutions, vitamin K, platelet transfusion before implantation of central venous catheter, and antibiotics. After 36 hours, we started plasma exchange (PEX). Blood tests showed deficiency of ADAMTS13. Due to the presence of anti-ADAMTS13 autoantibodies, rituximab was administered. Due to generalized tonic-clonic seizures, he was artificially ventilated. Brain MR angiography showed small ischemic cerebro-vascular insult in the arteria cerebri media region. Despite immunosuppressive therapy and PEX, the patient did not improve completely until the H. pylori infection was eradicated. After which, he recovered completely. Conclusions: We present a rare case of TTP accompanied with appendicitis and gastritis caused by H. pylori, where TTP improvement was dependent on H. pylori infection eradication. |
Databáze: | OpenAIRE |
Externí odkaz: |