Thrombotic Microangiopathy Due to Malignant Hypertension Treated Exclusively With Antihypertensive Therapy

Asano, Taro; Mori, Hideki

doi:10.7759/cureus.21835

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…[74,75] Several patients have been reported to be in remission with blood pressure control alone without PE. [76–78] In this case, malignant hypertension-induced TMA was considered; however, severe thrombocytopenia was observed and atypical. Several previous reports on COVID-19-related TMA have described patients with a history of hypertension.…”

Section: Discussionmentioning

confidence: 99%

Coronavirus disease 2019-associated thrombotic microangiopathy treated with plasma exchange and antihypertensive therapy in a patient with HIV: A case report with literature review

Masuda,

Fukushima,

Hebisawa

et al. 2023

Medicine

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Rationale: Coronavirus disease 2019 (COVID-19) is an infectious disease that often causes complications in multiple organs and thrombosis due to abnormal blood coagulation. This case report aimed to describe the clinical course of COVID-19-associated thrombotic microangiopathy (TMA) and reviewed the comprehensive information on TMA, thrombotic thrombocytopenic purpura (TTP), and atypical hemolytic uremic syndrome associated with COVID-19 in the past literature. Patient concerns: A 46-year-old Japanese man was diagnosed with human immunodeficiency virus infection 10 years ago and treated with antiretroviral therapy. The patient presented with fever, malaise, hematuria, and bilateral upper abdominal discomfort for the past 4 days. Diagnoses: COVID-19-associated TMA was diagnosed based on a positive polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 and laboratory findings such as thrombocytopenia, acute kidney injury, and hemolytic anemia. Malignant hypertension and human immunodeficiency virus infection were also considered as differential diagnoses of TMA. Interventions: Considering the possibility of TTP, plasma exchange was performed, and glucocorticoids were administered. Hemodialysis was performed for acute kidney injury. Antihypertensive drugs were administered to control the high blood pressure. Outcomes: Platelet count and renal function improved, and hemodialysis was no longer required. The patient was in good general condition and was discharged from the hospital. Lessons: COVID-19-associated TMA should be considered as a differential diagnosis during the COVID-19 epidemic. Excessive inflammation and severe COVID-19 are not essential for TMA development. Early intervention using conventional TMA treatments, such as plasma exchange and corticosteroids, might be important in improving prognosis while differentiating between TTP and atypical hemolytic uremic syndrome. Antihypertensive therapy may be helpful in the treatment of COVID-19-associated TMA.

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Section: Discussionmentioning

confidence: 99%

Coronavirus disease 2019-associated thrombotic microangiopathy treated with plasma exchange and antihypertensive therapy in a patient with HIV: A case report with literature review

Masuda,

Fukushima,

Hebisawa

et al. 2023

Medicine

View full text Add to dashboard Cite

show abstract

“…PLASMIC score greater than 6 is highly predictive of TTP and a score less than 5 is a low risk for TTP [ 5 ]. Unlike TTP, patients with TMA secondary to severe hypertension respond well to antihypertensive medications and do not require plasma exchange but may, unfortunately, progress to persistent renal failure [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Thrombotic Microangiopathy Secondary to Hypertensive Emergency

Bandaru¹,

Anaji²,

Stowe³

2022

Cureus

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Hypertension causing thrombotic microangiopathy (TMA) is one of the several etiologies of TMA, which causes endothelial damage and thrombosis of microvasculature, leading to hemolytic anemia, thrombocytopenia, and ischemic organ damage. Renal microvasculature involvement leading to renal dysfunction is most frequently seen in TMA but the degree of dysfunction varies with etiology. If left untreated, TMA carries a risk of high mortality, so it is extremely important for early identification of the cause of TMA. Plasma exchange is a commonly used treatment modality for TMA; however, it is not always necessary. Hypertension-induced TMA can be safely treated with antihypertensives, without the need for invasive plasma exchange. We report a 37-year-old African American hypertensive lady presenting with hypertensive emergency and TMA with rapidly progressing renal dysfunction. The patient had improvement in her platelet count after her blood pressure was reduced in a controlled manner.

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Thrombotic Microangiopathy Due to Malignant Hypertension Treated Exclusively With Antihypertensive Therapy

Cited by 2 publications

References 9 publications

Coronavirus disease 2019-associated thrombotic microangiopathy treated with plasma exchange and antihypertensive therapy in a patient with HIV: A case report with literature review

Coronavirus disease 2019-associated thrombotic microangiopathy treated with plasma exchange and antihypertensive therapy in a patient with HIV: A case report with literature review

A Case of Thrombotic Microangiopathy Secondary to Hypertensive Emergency

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