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Mostel Z, Nguyen BA, Costanzo L, Bankhead S, Ayat P, Taluru H, Puskoor A, Ahmed Z, Chiu E, El Sehamy A, Smith DN. Thrombotic Thrombocytopenic Purpura due to Varicella-Zoster Virus Meningoencephalitis in an Immunocompetent Patient. J Glob Infect Dis 2023; 15:172-174. [PMID: 38292692 PMCID: PMC10824231 DOI: 10.4103/jgid.jgid_241_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 02/01/2024] Open
Abstract
Varicella-zoster virus (VZV) can cause variable disease states in individuals with intact and compromised immune systems. Both meningoencephalitis and thrombotic thrombocytopenic purpura (TTP) are uncommon, life-threatening entities associated with VZV. There are few reported cases of TTP due to VZV and this may be the first case of TTP due to VZV meningoencephalitis confirmed through lumbar puncture. The literature tends to emphasize that this pathology mostly occurs in immunocompromised hosts. Here, we present a unique case of TTP due to VZV meningoencephalitis in a patient that was immunocompetent.
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Affiliation(s)
- Zachary Mostel
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Ben Anthony Nguyen
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Louis Costanzo
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Sarah Bankhead
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Parinaz Ayat
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Harsha Taluru
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Anoop Puskoor
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Zahra Ahmed
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Edwin Chiu
- Department of Medicine, Division of Hematology and Oncology, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - Adam El Sehamy
- Department of Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
| | - David Nathaniel Smith
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, NYC Health and Hospitals/Kings County Hospital Center, Brooklyn, NY, USA
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A 35-year-old woman with influenza A-associated thrombotic thrombocytopenic purpura. Blood Coagul Fibrinolysis 2016; 26:469-72. [PMID: 25688460 DOI: 10.1097/mbc.0000000000000255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A previously healthy 35-year-old woman presented with severe thrombotic thrombocytopenic purpura (TTP) affecting several organs and concomitant influenza A infection. On admission to hospital, haemoglobin was 5.4 g/dl, platelet count 6 × 10/l, Schistocyte count in peripheral blood 5%, and throat swab positive for influenza A RNA. The patient was treated with antiviral medication and transfusions of fresh frozen plasma before plasma exchange therapy with excellent response. Plasmaphereses were attenuated after 5 days, resulting in TTP relapse 3 days later. A disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) protein was very low (<0.04 U/l) and anti-ADAMTS13 elevated (>2 U/l), consistent with acquired TTP. Platelet counts normalized after five additional plasma exchanges and oral corticosteroids. Antinuclear antibodies and subgroup anti-Ro/Sjögren's syndrome A antigen (SSA) were detected in serum and have remained borderline-elevated, although evaluation during TTP, recovery and follow-up have lacked clinical manifestations of connective tissue disease. Influenza A infection induced production of ADAMTS13 inhibitor, which resulted in TTP in a patient with circulating antinuclear antibodies, lacking other manifestations of connective tissue disease.
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Thrombotic thrombocytopenic purpura in a patient with lenalidomide-responsive multiple myeloma. Ann Hematol 2015; 94:1605-7. [DOI: 10.1007/s00277-015-2421-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/01/2015] [Indexed: 11/26/2022]
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Thrombotic thrombocytopenic purpura as initial and major presentation of multiple myeloma. J Thromb Thrombolysis 2013; 36:422-3. [DOI: 10.1007/s11239-013-0893-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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