ADAMTS13 Deficiency and Thrombotic Thrombocytopenic Purpura Associated with Trimethoprim-Sulfamethoxazole

Abstract

Case PresentationA previously healthy woman, age 26 years, presented with abdominal pain, progressive fatigue, and purpuric skin rash over the extremities that began 7 days after beginning a treatment with trimethoprim-sulfamethoxazole (TMP-SMX) for a Klebsiella pneumoniae urinary tract infection. She also complained of exertional shortness of breath with no cough, hemoptysis, or other cardiopulmonary symptoms. No history of bleeding gums or hematochezia was present. A detailed interrogation did not demonstrate any other recent clinical complaints or the administration of any other type of medication beyond TMP-SMX. Physical examination revealed a young woman in no obvious distress, with a body mass index of 27 and stable vital signs. She had pallor and icterus of the mucus membranes but had no bleeding gums or rectal bleeding. She had a non-itchy, purpuric skin rash over her extremities, as well as petechiae. The rest of her physical examination was unremarkable. Thrombotic thrombocytopenic purpura (TTP) is a hematological disease characterized by microangiopathic hemolytic anemia and thrombocytopenia. Although the link between ADAMTS13 deficiency and idiopathic TTP has been well-established, the role of trimethoprimsulfamethoxazole (TMP-SMX) in the pathogenesis of TTP is not yet well elucidated. To the best of our knowledge, there have been only two previous reports linking this medication with the development of TTP. We present the case of a healthy woman, age 26 years, who developed TTP during TMP-SMX therapy for urinary tract infection. She was found to have ADAMTS13 deficiency with anti-ADAMTS13 antibodies. Her condition responded to discontinuation of the TMP-SMX, plasmapheresis, and rituximab therapy. We speculate that the acquired ADAMTS13 deficiency might have been triggered by the TMP-SMX therapy.

Effect of co-administered lopinavir/ritonavir and sulfamethoxazole/trimethoprim on cardiac function and architecture of albino rats

“…Changes in hematological parameters observed in rats treated with SMX/TMP are in agreement with some observations. 15,16 Mallolas et al, 17 in their study reported some cases of LPV/r associated impairments in hematological function which disagrees with observations in this study. 18 Concurrent use of these agents may not have any deleterious effects on hematologic parameters as observed in this study.…”

Mitomycin-Induced Thrombotic Thrombocytopenic Purpura Treated Successfully With Plasmapheresis and Steroid: A Case Report

“…TTP has diverse etiologies, including cancer, infection, stem cell transplantation, organ transplantation, and medication such as chemotherapy. Drug-related TTP is common and represents 12% of cases [ 7 ]. TTP can be divided into hereditary and acquired.…”

Ciprofloxacin-Induced Thrombotic Thrombocytopenic Purpura: A Case of Successful Treatment and Review of the Literature

“…TTP has diverse etiologies including infections, medications, and idiopathic and familial causes. Drug-associated TTP represents about 12% of all cases [ 9 ]. Before the advent of plasma therapy, most of the patients presenting with acute TTP died: the case-fatality rate reported in clinical series was near 100% until the 1960s [ 10 , 11 ].…”