Thrombotic Thrombocytopenic Purpura During Penicillamine Therapy in Rheumatoid Arthritis

Trice, James M.; Pinals, Robert S.; Plitman, Gerald I.

doi:10.1001/archinte.1983.00350070215039

Cited by 13 publications

(2 citation statements)

References 12 publications

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“…A second inconclusive report appeared in 1963 of rheumatoid arthritis associated with TTP; the diagnosis of TTP was doubtful due to decreased megakaryocytes in the bone marrow and the lack of thrombi in the microvasculature (6). The third report described TTP in rheumatoid arthritis secondary to D‐penicillamine therapy (7). Our patient was treated by TPE with FFP replacement and glucocorticoid therapy; this is an established mode of treatment in TTP (8).…”

Section: Discussionmentioning

confidence: 92%

Thrombotic Thrombocytopenic Purpura in a Patient with Rheumatoid Arthritis Treated by Plasmapheresis

Baz¹,

Mahfouz²,

Masri

1999

Therapeutic Apheresis

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Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia, and neurologic symptoms. TTP is associated with many diseases and several therapeutic drugs. We report the rare case of a patient with rheumatoid arthritis who developed TTP that was not associated with drug therapy, 18 months after the onset of rheumatoid arthritis. She recovered from the TTP following daily sessions of therapeutic plasma exchange (TPE) with fresh frozen plasma replacement and glucocorticoid therapy. Recent pathogenic mechanisms are reviewed as they relate to von Willebrand factor. In this report of the rare association of TTP with rheumatoid arthritis, an immediate relationship is likely because both are of an immune nature. Awareness of the possible development of TTP in rheumatoid arthritis is important for early diagnosis and treatment.

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Section: Discussionmentioning

confidence: 92%

Thrombotic Thrombocytopenic Purpura in a Patient with Rheumatoid Arthritis Treated by Plasmapheresis

Baz¹,

Mahfouz²,

Masri

1999

Therapeutic Apheresis

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“…In this case, there were systemic thrombi formations, fragmentation of blood cells, and no signs of vasculitis. Some authors [10][11][12] have reported TTP during dpenicillamine therapy, and these cases led to remission when treated with prednisolone, fresh frozen plasma, and plasma exchange after discontinuation of the d-penicillamine therapy. Although the mechanisms of drug-induced TTP are not clear, the reactive sulfhydryl group on penicillamine could bind with membrane proteins and alter them sufficiently to induce antibody formation either to the drug acting as a hapten or to unmasked antigenic determinations on the membrane.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic thrombocytopenic purpura in a patient with rapidly progressive scleroderma

Bohgaki

Notoya

Kohno

et al. 2000

Modern Rheumatology

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A 57-year-old man presented with palpitations, shortage of breath on exertion, and rapidly progressive scleroderma. On admission, a computed tomographic scan of his lung showed active interstitial pneumonia. We treated him with d-penicillamine and intravenous pulse methylprednisolone. After this treatment, severe abdominal pain, microangiopathic hemolytic anemia, thrombocytopenia, and progressive renal involvement appeared. We diagnosed him as having systemic sclerosis (SSc) complicated by thrombotic thrombocytopenic purpura. At postmortem, thromboses of capillaries, arterioles, and small arteries were found in several organs. As well as the differential diagnosis of SSc with thrombocytopenia, microangiopathic hemolytic anemia (MAHA), and renal involvement, we diagnosed scleroderma renal crisis (SRC), normotensive renal crisis (NRC), and SSc complicated by TTP. Typical SRC and NRC were excluded because his blood pressure was in the normal range without elevation of plasma renin activity or azotemia over his clinical course. Although distinguishing TTP from renal crisis is difficult, an evaluation of ultra-large multimers of von Willebrand factor (UL-vWF) concentration may be helpful in these situations.

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D,3‐Mercaptovaline 52‐67‐5

2004

Sax's Dangerous Properties of Industrial Materials

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Thrombotic Thrombocytopenic Purpura During Penicillamine Therapy in Rheumatoid Arthritis

Cited by 13 publications

References 12 publications

Thrombotic Thrombocytopenic Purpura in a Patient with Rheumatoid Arthritis Treated by Plasmapheresis

Thrombotic Thrombocytopenic Purpura in a Patient with Rheumatoid Arthritis Treated by Plasmapheresis

Thrombotic thrombocytopenic purpura in a patient with rapidly progressive scleroderma

D,3‐Mercaptovaline 52‐67‐5

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