Streptococcus pneumoniae-associated thrombotic microangiopathy in an immunosuppressed adult

Abstract

<jats:title>Abstract</jats:title><jats:p>A 62-year-old male who was receiving prednisolone and methotrexate for scleroderma and rheumatoid arthritis complained of diarrhea and vomiting, and was transferred to our hospital for detailed examination and treatment of renal dysfunction and thrombocytopenia. Hemolytic anemia and crushed erythrocytes were found during the patient’s course; therefore, we suspected thrombotic microangiopathy (TMA). His ADAMTS13 activity was 60.3% and his ADAMTS13 inhibitor was under 0.5. In addition, his blood culture was positive for <jats:italic>Streptococcus pneumoniae</jats:italic>, and we finally diagnosed <jats:italic>Streptococcus pneumoniae</jats:italic>-associated TMA (pTMA). The patient was treated with antibiotics and hemodialysis. The patient recovered and was discharged on the 45<jats:sup>th</jats:sup> hospital day. Adult pTMA cases are remarkably rare. We herein report a successfully treated adult case of pTMA.</jats:p>

A Thrombotic Thrombocytopenic Purpura-Like Syndrome in HIV and Streptococcus pneumoniae Meningitis

“…Although he had a platelet count, combined hemolysis variable, absence of active cancer, absence of stem-cell or solid-organ transplant, mean corpuscular volume, INR, creatinine (PLASMIC) score of 4 and his ADAMTS13 levels were normal, his sustained improvement following plasmapheresis supports the diagnosis of a TTP-like syndrome [11]. Cases of Streptococcus pneumoniae-associated TTP have been previously described and are likely the precipitating factor in our patient's case [12,13]. Our patient's clinical course suggests that providers should consider plasmapheresis as a treatment option for such individuals.…”