Nonsteroidal Anti-inflammatory Drug Induced Thrombotic Thrombocytopenic Purpura

Abstract

A 21-year-old male presented to the emergency department after a 5-day history of recurrent vomiting and decreased urine output. History revealed ingestion of ibuprofen. During the diagnostic workup, the following was identified: white blood cell count 13.4 (×10(3)/mcL), hemoglobin 11.9 (×10(6)/mcL) with an MCV of 73 fL, hematocrit 34% and platelets were 31,000/mcL, sodium of 130 mmol/L, potassium of 5.1 mmol/L, chloride of 83 mmol/L, bicarbonate of 21 mmol/L, blood urea nitrogen of 184 mg/dL and creatinine of 19.1 mg/dL. He was later diagnosed with thrombotic thrombocytopenic purpura (TTP) based on the fact that he presented with most components of the TTP pentad (except for fever), which included altered mental status, acute kidney injury, thrombocytopenia, and evidence of red cell fragmentation and his ADAMTS13 level was found to be less than 10% prior to therapy. The patient then received plasma exchange, oral corticosteroids, and hemodialysis, which led to a full recovery of platelet count and renal function.

Diclofenac-induced thrombotic thrombocytopenic purpura with concomitant complement dysregulation: a case report and review of the literature

“…Some of the identifiable risk factors include immunosuppressive therapy, human immunodeficiency virus (HIV) infections, malignancy, pancreatitis, post-surgical state, post-partum state, and post-pneumococcal infection state. Standard drugs that can cause TTP include antibiotics, oral contraceptive pills, extended-release opioids, valacyclovir, as well as chemotherapeutic agents such as mitomycin C, alkylating agents, and immunomodulators [3, 7]. In rare cases, NSAIDs may also cause TTP.…”

“…Oregel et al . reported a case of a 21-year-old man who attempted suicide by ingesting ibuprofen and subsequently developed TTP, which responded favorably to plasma exchange therapy [7]. Benmoussa et al .…”

Cumulative Review of Thrombotic Microangiopathy, Thrombotic Thrombocytopenic Purpura, and Hemolytic Uremic Syndrome Reports with Subcutaneous Interferon β-1a

“…Ibuprofen is used to alleviate flu-like symptoms in patients with MS during treatment with IFN β-1a [ 14 ]. Case reports have presented ibuprofen use in patients who developed TMA [ 15 ] and TTP [ 16 ], although an association has not been reported in patients with MS who received sc IFN β-1a treatment. Regarding E. coli exposure, recent cases of TMA/TTP-HUS associated with sc IFN β-1a treatment were reported in Canada [ 2 ] and Scotland [ 11 ], and were not geographically localized.…”