A case of severe thrombotic thrombocytopenic purpura with concomitant Legionella pneumonia: review of pathogenesis and treatment.

Journal Article (Journal Article)

Thrombotic thrombocytopenia purpura (TTP) is a severe multisystem disorder characterized by fever, microangiopathic hemolytic anemia, thrombocytopenia, neurologic symptoms, and impaired renal function. Platelet counts are usually diminished, whereas the bone marrow shows a large number of megakaryocytes indicating peripheral destruction and consumption of platelets. Coagulation studies in patients with TTP are normal or slightly elevated, which helps differentiate this entity from disseminated intravascular coagulation. The peripheral smear shows an abundance of schistocytes, reticulocytes, and, at times, nucleated red blood cells. Serum lactate dehydrogenase and indirect bilirubin are elevated as a result of mechanical destruction of red blood cells. Legionella pneumophila has been identified as a relatively common cause of both community-acquired and hospital-acquired pneumonia. An association between Legionella and TTP has only been cited once in the literature. Here we present a case of severe TTP with concurrent Legionella infection. Our patient presented with the classic clinical findings of TTP and an ADAMTS13 level of less than 5% associated with an inhibitor. After a 3-week treatment course with plasma exchange, steroids, and antibiotics, he had complete clinical recovery and his ADAMTS13 level increased to greater than 75%.

Full Text

Duke Authors

Cited Authors

  • Talebi, T; Fernandez-Castro, G; Montero, AJ; Stefanovic, A; Lian, E

Published Date

  • September 2011

Published In

Volume / Issue

  • 18 / 5

Start / End Page

  • e180 - e185

PubMed ID

  • 20216382

Electronic International Standard Serial Number (EISSN)

  • 1536-3686

Digital Object Identifier (DOI)

  • 10.1097/MJT.0b013e3181d1b4a1


  • eng

Conference Location

  • United States