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Luciano J, Gilardin L, Nocturne G, Bouzid R, Veyradier A, Mariette X, Coppo P, Bonnet I, Joly BS. Clinical, biological, prognostic characteristics of patients with immune-mediated thrombotic thrombocytopenic purpura and Sjögren's disease. RMD Open 2024; 10:e004426. [PMID: 39209728 PMCID: PMC11367322 DOI: 10.1136/rmdopen-2024-004426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES The association between immune-mediated thrombotic thrombocytopenic purpura (iTTP) and Sjögren disease (SjD) has been poorly investigated. This study presents the first retrospective cohort of iTTP-SjD aiming to identify risk factors for iTTP occurrence in SjD patients and examine their clinical course. METHODS Patients with iTTP-SjD were identified within the French TTP Registry based on American College of Rheumatology/European League Against Rheumatism 2016 criteria. A comparative analysis was conducted with two control groups comprising primary SjD (pSjD) patients from the French ASSESS cohort and idiopathic iTTP patients from the French TTP Registry. Demographic, clinical and biological data were retrospectively collected. RESULTS Thirty iTTP-SjD patients were included and compared with 65 pSjD and 45 idiopathic iTTP patients. The majority of iTTP-SjD patients (n=18) were diagnosed with SjD at the time of iTTP diagnosis. In comparison with the pSjD cohort, iTTP-SjD patients were diagnosed with SjD at a younger age (p=0.039) and showed a higher prevalence of anti-SjS-related antigen A antibody positivity and xerostomia (p=0.015, p=0.035, respectively). EULAR Sjogren's Syndrome Disease Activity Index showed similar activity levels between the two groups. iTTP-SjD patients were treated with plasma exchange (n=28), corticosteroids, rituximab (n=19) and caplacizumab (n=3). In comparison with the idiopathic iTTP cohort, mortality rates (log-rank tests, p=0.228), biological and clinical iTTP relapses (multivariate analysis, p=0.181) were comparable and short-term outcomes (survival at day 30, relapse) were favourable. CONCLUSION iTTP can be a rare complication in patients with SjD. Further studies involving larger cohorts and long-term follow-up are warranted to confirm these findings and to explore the efficacy of immunomodulators and caplacizumab in iTTP-SjD patients.
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Affiliation(s)
- Justine Luciano
- Inserm, CEA, Immunologie des maladies virales, auto-immunes, hématologiques et bactériennes (IMVA-HB/IDMIT/UMR1184), Université Paris-Saclay, Le Kremlin Bicêtre, France
- Département de Rhumatologie, Hôpital Bicêtre, AP-HP, INSERM UMR1184, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Laurent Gilardin
- Service de Médecine interne, Hôpital Jean Verdier, AP-HP. Hôpitaux Universitaires Paris Seine-Saint-Denis, Bondy, France
- INSERM UMRS-1138, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
- Centre National de Référence des Microangiopathies Thrombotiques (CNR-MAT), Hôpital Saint-Antoine, AP-HP.6. Sorbonne Université, Paris, France
| | - Gaétane Nocturne
- Inserm, CEA, Immunologie des maladies virales, auto-immunes, hématologiques et bactériennes (IMVA-HB/IDMIT/UMR1184), Université Paris-Saclay, Le Kremlin Bicêtre, France
- Département de Rhumatologie, Hôpital Bicêtre, AP-HP, INSERM UMR1184, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Raïda Bouzid
- INSERM UMRS-1138, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
- Centre National de Référence des Microangiopathies Thrombotiques (CNR-MAT), Hôpital Saint-Antoine, AP-HP.6. Sorbonne Université, Paris, France
| | - Agnès Veyradier
- INSERM UMRS-1138, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
- Centre National de Référence des Microangiopathies Thrombotiques (CNR-MAT), Hôpital Saint-Antoine, AP-HP.6. Sorbonne Université, Paris, France
- Service d'Hématologie Biologique, Hôpital Lariboisière, AP-HP. Nord, Université Paris Cité, Paris, France
| | - Xavier Mariette
- Inserm, CEA, Immunologie des maladies virales, auto-immunes, hématologiques et bactériennes (IMVA-HB/IDMIT/UMR1184), Université Paris-Saclay, Le Kremlin Bicêtre, France
- Département de Rhumatologie, Hôpital Bicêtre, AP-HP, INSERM UMR1184, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Paul Coppo
- INSERM UMRS-1138, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
- Centre National de Référence des Microangiopathies Thrombotiques (CNR-MAT), Hôpital Saint-Antoine, AP-HP.6. Sorbonne Université, Paris, France
- Service d'Hématologie, Hôpital Saint-Antoine, AP-HP.6. Sorbonne Université, Paris, France
| | - Isabelle Bonnet
- Département de Rhumatologie, Hôpital Bicêtre, AP-HP, INSERM UMR1184, Université Paris Saclay, Le Kremlin Bicêtre, France
- Département de Rhumatologie, Hôpital Universitaire de Nîmes, Université de Nîmes, Nîmes, France
| | - Bérangère S Joly
- INSERM UMRS-1138, Centre de Recherche des Cordeliers, CNRS, Sorbonne Université, Université Paris Cité, Paris, France
- Centre National de Référence des Microangiopathies Thrombotiques (CNR-MAT), Hôpital Saint-Antoine, AP-HP.6. Sorbonne Université, Paris, France
- Service d'Hématologie Biologique, Hôpital Lariboisière, AP-HP. Nord, Université Paris Cité, Paris, France
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Ziv A, Dardik R, Yacobovich J, Uziel Y, Haviv R, Avishai E, Kenet G, Toren A, Barel O, Barg AA. Atypical Presentations of Pediatric-acquired Thrombotic Thrombocytopenic Purpura. J Pediatr Hematol Oncol 2024; 46:306-310. [PMID: 38934698 DOI: 10.1097/mph.0000000000002914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Immune thrombotic thrombocytopenic purpura (iTTP) in children is a rare, severe thrombotic microangiopathy. This condition is characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia due to reduced activity of the von Willebrand factor-cleaving protease ADAMTS13. METHODS A retrospective case series evaluating data collected from the medical files of 4 children diagnosed with iTTP. RESULTS The presented case series depicts a variety of iTTP presentations: 1 case of primary iTTP, 1 case induced by Shiga toxin, 1 associated with RAS-associated autoimmune leukoproliferative disease (RALD), and 1 initial manifestation of systemic lupus erythematosus (SLE). Notably, 2 patients recovered without undergoing plasma exchange. CONCLUSION Early ADAMTS13 testing in children with unexplained hemolysis or thrombocytopenia is crucial. The diverse underlying causes, including infections and autoimmune disorders, underscore the complexity of iTTP in the pediatric population. These cases highlight the necessity for personalized treatment approaches that consider each patient's unique clinical situation and potential alternatives or modifications to conventional therapeutic regimens.
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Affiliation(s)
- Amit Ziv
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba
| | - Rima Dardik
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer
| | - Joanne Yacobovich
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petach Tikva
| | - Yosef Uziel
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba
| | - Ruby Haviv
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba
| | - Einat Avishai
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer
| | - Gili Kenet
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer
| | - Amos Toren
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- Division of Pediatric Hematology and Oncology, The Edmond and Lily Safra Children's Hospital
| | - Ortal Barel
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- Bioinformatics Unit, Sheba Cancer Research Center and Wohl Institute for Translational Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Assaf Arie Barg
- Faculty of Medicine, Tel Aviv University, Tel Aviv
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer
- Division of Pediatric Hematology and Oncology, The Edmond and Lily Safra Children's Hospital
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Darba J, Ascanio M, Agüera A. Incidence and medical costs of lupus in Spanish hospitals: a retrospective database analysis. Orphanet J Rare Dis 2024; 19:74. [PMID: 38365713 PMCID: PMC10874055 DOI: 10.1186/s13023-024-03077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/04/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND This study aimed to assess the comorbidity profile, use of healthcare resources and medical costs of patients with systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE) treated at the hospital level in Spain. METHODS Admission records of patients with SLE and CLE that were registered between January 2016 and December 2020 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study. RESULTS 329 patients met the criteria; 64.44% were female and 35.56% were male, with a median age of 54.65 years. Mean Charlson comorbidity index (CCI) was 2.75 in the index admission. 31.61% of the patients suffered essential hypertension, 21.96% suffered asthma and 19.76% suffered hyperlipidemia. Mortality rate was 3.95%. The most common medical procedure was heart ultrasound (19.45%) and introduction in peripheral vein of anti-inflammatory with a percutaneous approach (17.93%). Mean admission cost was €6355.99. CONCLUSIONS Lupus patients showed a higher incidence and prevalence in the female population, with associated cardiac diseases as the main secondary conditions.
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Affiliation(s)
- Josep Darba
- Department of Economics, University of Barcelona, Diagonal 690, 08034, Barcelona, Spain.
| | - Meritxell Ascanio
- BCN Health Economics & Outcomes Research S.L., Travessera de Gràcia, 62, 08006, Barcelona, Spain
| | - Ainoa Agüera
- BCN Health Economics & Outcomes Research S.L., Travessera de Gràcia, 62, 08006, Barcelona, Spain
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Bruns L, Völker L, Klamroth R, Kuhlmann MK, Jabs WJ. Concomitant presentation of thrombotic thrombocytopenic purpura, immune thrombocytopenia, and autoimmune hemolytic anemia in a patient with newly diagnosed systemic lupus erythematosus. Clin Nephrol Case Stud 2023; 11:147-153. [PMID: 38170038 PMCID: PMC10759207 DOI: 10.5414/cncs111193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/21/2023] [Indexed: 01/05/2024] Open
Abstract
Thrombocytopenia is always of concern when encountered in emergency settings. We report a case of a 29-year-old women in whom a unique constellation of hematological disorders occurred. The patient had been diagnosed with idiopathic immune thrombocytopenia (ITP) in 2007, with a history of several thrombocytopenic flares. She now presented with homonymous hemianopia accompanied by thrombocytopenia and microangiopathic hemolytic anemia (MAHA) and was soon after diagnosed with a posterior stroke. Symptoms were more reminiscent of acquired thrombotic thrombocytopenic purpura (aTTP) rather than ITP. Immediate treatment with plasma exchange and caplacizumab curtailed MAHA, and progressive ischemic disease was averted. ADAMTS-13 testing confirmed the diagnosis of immune-mediated aTTP. Repeated testing for ITP, however, also showed IgG-loaded thrombocytes with the former known anti-GPIIb/IIIa specificity. Furthermore, autoimmune hemolytic anemia (AIHA) could be detected by direct antiglobulin test showing IgG and complement loading of the patient's erythrocytes. The autoimmune background of all three entities suggested an underlying systemic disease. Indeed, systemic lupus erythematosus (SLE) serology was strongly positive allowing for the diagnosis of SLE. ITP and AIHA as well as aTTP can be secondary to SLE, but emergence of all three disorders has not been reported at the same time.
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Affiliation(s)
- Lina Bruns
- Department of Nephrology, Vivantes Clinic in Friedrichshain, Berlin
| | - Linus Völker
- Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC), University Hospital Cologne, Cologne, and
| | - Robert Klamroth
- Department of Angiology and Hemostaseology, Vivantes Clinic in Friedrichshain, Berlin, Germany
| | | | - Wolfram J. Jabs
- Department of Nephrology, Vivantes Clinic in Friedrichshain, Berlin
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5
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Dimopoulos K, Tripodi A, Goetze JP. Laboratory investigation and diagnosis of thrombotic thrombocytopenic purpura. Crit Rev Clin Lab Sci 2023; 60:625-639. [PMID: 37452521 DOI: 10.1080/10408363.2023.2232039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/04/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially fatal disease for which rapid diagnosis is crucial for patient outcomes. Deficient activity (< 10%) of the liver enzyme, ADAMTS13, is the pathophysiological hallmark of TTP, and measurement of the enzyme activity can establish the diagnosis of TTP with high accuracy. Thus, along with the clinical history, appropriate laboratory assessment of a suspected case of TTP is essential for diagnosis and treatment. Here, we present a review of the available laboratory tests that can assist clinicians in establishing the diagnosis of TTP, with special focus on ADAMTS13 assays, including the measurement of the antigen and activity, and detection of autoantibodies to ADAMTS13.
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Affiliation(s)
- Konstantinos Dimopoulos
- Department of Clinical Biochemistry, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Armando Tripodi
- IRCCS Maggiore Hospital Foundation, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milano, Italy
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health, Copenhagen University, Copenhagen, Denmark
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Pramanik D, Bhardwaj D, Karmani VK, Raval GG, Kutlar A. Successful Treatment of Refractory Thrombotic Thrombocytopenic Purpura (TTP) With Caplacizumab: A Case Report. Cureus 2023; 15:e42423. [PMID: 37637544 PMCID: PMC10448709 DOI: 10.7759/cureus.42423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
We report a female patient who presented with generalized weakness, episodes of altered mental status and slurred speech, and a history of systemic lupus erythematosus. Initial investigations showed profound thrombocytopenia and schistocytosis on peripheral blood smear. PLASMIC score was promptly calculated, and plasma exchange with steroids was initiated based on the initial high PLASMIC score. Bone marrow examination showed hypocellular marrow without any other obvious abnormalities. The patient's platelet counts initially improved but had a quick decline, on which, rituximab and subsequently caplacizumab were introduced. The patient was discharged after stabilization with plasma exchange (PLEX) therapy as needed on an outpatient basis.
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Affiliation(s)
| | | | - Vikash K Karmani
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Girindra G Raval
- Medicine: Hematology and Oncology, Medical College of Georgia at Augusta University, Augusta, USA
| | - Abdullah Kutlar
- Medicine: Hematology and Oncology, Medical College of Georgia at Augusta University, Augusta, USA
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Liang SJ, Zheng QY, Li MS, Lv MY, Chen WT, Yang Y. Response to belimumab in thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus: a case-based review. Clin Rheumatol 2022; 41:2561-2569. [PMID: 35524885 DOI: 10.1007/s10067-022-06155-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
Abstract
Thrombotic thrombocytopenic purpura (TTP), a life-threatening syndrome characterized by acute microangiopathic hemolytic anemia, thrombocytopenia, and visceral ischemia, can be classified as congenital TTP (inherited due to a mutation in ADAMTS13) and acquired TTP. The acquired TTP is further classified as idiopathic and secondary TTP. Systemic lupus erythematosus (SLE) is regarded as one of the most common causes of secondary TTP (SLE-TTP). In contrast to patients with idiopathic TTP, some patients with SLE-TTP, especially those diagnosed with refractory TTP, are resistant to plasma exchange and high-dose corticosteroids and usually require second-line drugs, including newly developed biologicals. Belimumab, a B-lymphocyte stimulator-specific inhibitor, was the first approved new therapy for SLE in the past 50 years. Only two cases of SLE-TTP using belimumab have been reported; however, detailed information has not been made available. Herein, we describe a 28-year-old female patient who presented with palm petechiae, strong tawny urine, and yellow stained skin and sclera, and was diagnosed with SLE-TTP supported by high anti-ANA titers; positive anti-SSA/SM; pleural effusion; decreased platelet count, hemoglobin, and complement C3/C4 counts; increased lactate dehydrogenase level, along with increased schistocytes; and a significant deficiency of ADAMTS13 activity. Belimumab (10 mg/kg) was administered after six plasma exchanges. Good efficiency and outcomes without any adverse events, SLE, or TTP relapse were observed during 12 months of follow-up. Therefore, belimumab is a promising choice for SLE-TTP management. In addition, we provide a focused review of the existing literature on the pathogenesis, diagnosis, and therapeutic strategies for SLE-TTP.
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Affiliation(s)
- Shen-Ju Liang
- Department of Rheumatology and Immunology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Quan-You Zheng
- Department of Nephrology and Urology, 958th Hospital, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400020, China
| | - Meng-Shan Li
- Department of Rheumatology and Immunology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Ming-Ye Lv
- Department of Rheumatology and Immunology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Wen-Ting Chen
- Department of Rheumatology and Immunology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Yi Yang
- Department of Rheumatology and Immunology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China.
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8
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The Efficacy and Safety of Plasma Exchange in the Treatment of Thrombotic Thrombocytopenic Purpura. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3519937. [PMID: 35399835 PMCID: PMC8989575 DOI: 10.1155/2022/3519937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
Abstract
Background Thrombotic thrombocytopenic purpura (TTP) is a clinically rare thrombotic cardiovascular and microvascular disease. The purpose of this study was to observe the clinical efficacy and safety of plasma exchange in the treatment of TTP. Methods A total of 16 TTP patients who underwent plasma exchange from January 2015 to December 2020 were selected. The clinical data of all patients were collected for retrospective analysis. The effective rate of treatment, the changes of blood cell count before and after treatment, and adverse reactions during treatment were analyzed. Results A total of 50 plasma exchanges were performed in 16 TTP patients. After plasma exchange treatment, there were 4 invalid and 12 improved patients. The total effective rate of plasma exchange in patients with TTP was 75.0%. After treatment, platelet count (PLT) and hemoglobin (Hb) levels were significantly increased in TTP patients. Compared with before treatment, lactate dehydrogenase (LDH), indirect bilirubin (IBIL), total bilirubin (TBIL), and broken red blood cells were significantly reduced. In addition, 3 adverse reactions occurred in 50 plasmapheresis procedures, and the incidence of adverse reactions was 6.0%. Conclusion Plasma exchange therapy has a good therapeutic effect on TTP and can significantly improve abnormal blood cell count in patients with high safety.
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Jung JY, Kim JW, Suh CH, Kim HA. Successful treatment of thrombotic thrombocytopenic purpura with plasmapheresis and anti-CD20 antibodies in a patient with immune thrombocytopenia and systemic lupus erythematosus: Case report. Medicine (Baltimore) 2022; 101:e28908. [PMID: 35363211 PMCID: PMC9282078 DOI: 10.1097/md.0000000000028908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/30/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology with diverse clinical and laboratory manifestations, including thrombocytopenia. About 25% of patients with SLE may be affected by thrombocytopenia, many of whom are asymptomatic. Some patients, however, experience platelet counts that drop quite low and predispose them to bleeding. Thrombotic thrombocytopenic purpura (TTP) is defined with a classic pentad of clinical features, such as thrombocytopenia, microangiopathic hemolytic anemia, neurological symptoms and signs, renal symptoms and signs, and fever. The association of TTP and SLE has been sporadically reported in the literature. PATIENT CONCERNS AND DIAGNOSIS We describe a 16-year-old girl with SLE and immune thrombocytopenia, in whom TTP was diagnosed. INTERVENTIONS AND OUTCOMES She was treated with pulse methylprednisolone, whose platelet counts normalized after therapy with plasmapheresis and an anti-CD20 monoclonal antibody (rituximab). CONCLUSION A pediatric patient with SLE and immune thrombocytopenia in whom TTP developed was treated with plasmapheresis and rituximab therapy successfully, though the patient experienced a disease relapsed after 18 months, which was controlled by the same management.
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MESH Headings
- Adolescent
- Anemia, Hemolytic/complications
- Child
- Female
- Humans
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/therapy
- Plasmapheresis
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Purpura, Thrombotic Thrombocytopenic/complications
- Purpura, Thrombotic Thrombocytopenic/diagnosis
- Purpura, Thrombotic Thrombocytopenic/therapy
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Affiliation(s)
- Ju-Yang Jung
- Department of Rheumatology, Ajou University of Medical School, Suwon, Korea
| | - Ji-Won Kim
- Department of Rheumatology, Ajou University of Medical School, Suwon, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University of Medical School, Suwon, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University of Medical School, Suwon, Korea
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Endo S, Fujinaga S, Takemasa Y, Oonuki Y, Sakuraya K. Thrombotic thrombocytopenic purpura as initial presentation of systemic lupus erythematosus. Pediatr Int 2022; 64:e15297. [PMID: 36163643 DOI: 10.1111/ped.15297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Shota Endo
- Division of Nephrology, Saitama Children's Medical Center, Saitama-City, Saitama, Japan
| | - Shuichiro Fujinaga
- Division of Nephrology, Saitama Children's Medical Center, Saitama-City, Saitama, Japan
| | - Yoichi Takemasa
- Division of Nephrology, Saitama Children's Medical Center, Saitama-City, Saitama, Japan
| | - Yuta Oonuki
- Division of Nephrology, Saitama Children's Medical Center, Saitama-City, Saitama, Japan
| | - Koji Sakuraya
- Division of Nephrology, Saitama Children's Medical Center, Saitama-City, Saitama, Japan
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Boesen EI, Kakalij RM. Autoimmune-mediated renal disease and hypertension. Clin Sci (Lond) 2021; 135:2165-2196. [PMID: 34533582 PMCID: PMC8477620 DOI: 10.1042/cs20200955] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/20/2021] [Accepted: 09/06/2021] [Indexed: 12/18/2022]
Abstract
Hypertension is a major risk factor for cardiovascular disease, chronic kidney disease (CKD), and mortality. Troublingly, hypertension is highly prevalent in patients with autoimmune renal disease and hastens renal functional decline. Although progress has been made over the past two decades in understanding the inflammatory contributions to essential hypertension more broadly, the mechanisms active in autoimmune-mediated renal diseases remain grossly understudied. This Review provides an overview of the pathogenesis of each of the major autoimmune diseases affecting the kidney that are associated with hypertension, and describes the current state of knowledge regarding hypertension in these diseases and their management. Specifically, discussion focuses on Systemic Lupus Erythematosus (SLE) and Lupus Nephritis (LN), Immunoglobulin A (IgA) Nephropathy, Idiopathic Membranous Nephropathy (IMN), Anti-Neutrophil Cytoplasmic Antibody (ANCA)-associated glomerulonephritis, and Thrombotic Thrombocytopenic Purpura (TTP). A summary of disease-specific animal models found to exhibit hypertension is also included to highlight opportunities for much needed further investigation of underlying mechanisms and novel therapeutic approaches.
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Affiliation(s)
- Erika I Boesen
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198, U.S.A
| | - Rahul M Kakalij
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198, U.S.A
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