Pancreatitis leading to thrombotic thrombocytopenic purpura in systemic lupus erythematosus: a case report and review of literature

Abstract

Pancreatitis is a well-establishedbut unusual complicationof thrombotic thrombocytopenicpurpura (TTP). It is also an unusual complication of systemic lupus erythematosus (SLE). However, TTP occurring as a consequence of acute pancreatitis in a patient with SLE has never been reported. We report a 24-year-old African American woman with active systemic lupus (SLE) who developed thrombotic thrombocytopenic purpura (TTP) following an episode of acute pancreatitis. The TTP was manifested by low-grade fever, microangiopathic hemolytic anemia, renal insufficiency, altered mental status, seizures and thrombocytopenia. The patient was initially treated with pulse corticosteroids with inadequate response and subsequentlywith daily plasmaphresis, leading to full remission. This case represents first report of pancreatitis leading to TTP in a patient with systemic lupus erythematosus.

Keywords

acute pancreatitis systemic lupus erythematosus thrombotic thrombocytopenic purpura

Get full access to this article

View all access options for this article.

References

Sultan SM , Ioannou Y , Isenberg DA. A review of gastrointestestinal manifestations of systemic lupus erythematosus . Rheumatology 1999; 38: 917-932 .

Jackson B , Files JC , Morrison F et al. Thrombotic thrombocytopenic purpura and pancreatitis . Am J Gastroenterol 1989; 84: 667-669 .

Olsen H. Thrombotic thrombocytopenic purpura as a cause of pancreatitis . Dig Dis 1973; 18: 238-246 .

Daryanani S , Wild JT. Relapsing thrombotic thrombocytopenic purpura in association with recurrent pancreatitis . Clin Lab Haematol 1998; 20: 317-318 .

Varadarajula S , Ramsey W , Israel H. Thrombotic thrombocytopenic purpura in acute pancreatitis . J Clin Gastroenterol 2000; 31: 243-245 .

Malka D , Levy P , Bernades P. Thrombotic thrombocytopenic purpura caused by acute pancreatitis in a woman with a pancreas divisum: a case report . Pancreas 1996; 12: 414-416 .

Vergara M , Modelell I , Puig-Divi V et al. Acute pancreatitis as a triggering factor for Thrombotic thrombocytopenic purpura . Am J Gastroenterol 1998; 93: 2215-2218 .

Silva VA. Thrombotic thrombocytopenic purpura= hemolytic uremic syndrome secondary to pancreatitis . Am J Hemat 1995; 50: 53-56 .

Ridolfi RL , Bell WR. Thrombotic thrombocytopenic purpura. Report of 25 cases and review of literature . Medicine 1981; 60: 413-428 .

10.

Petri M. Pancreatitis in systemic lupus erythematosus: Still in search of a mechanism . J Rheumatol 1992; 19: 1014-1016 .

11.

Musio F , Bohan EM , Yuan CM et al. Review of thrombotic thrombocytopenic purpura in the setting of systemic lupus erythematosus . Sem Arthritis Rheum 1998; 28: 1-19 .

12.

Durand JM , Lefevre P , Kaplanski G , Soubeyrand J. Thrombotic microangiopathy and the antiphospholipid antibody syndrome . J Rheumatol 1991; 18: 1916-1918 .

13.

Neuwelt CM , Daikh DI , Lin foot JA , Pfister DA et al. Catastrophic antiphospholipid syndrome: response to repeated plasmaphresis over three years . Arthritis Rheum 1997; 40(8): 1534-1539 .

14.

Alarcon-Segovia D , Deleze M , Oria CV et al. Antiphospholipid antibodies and antiphospholipid syndrome in systemic lupus erythematosus. A prospective analysis of 500 consecutive patients . Medicine 1989; 68: 353-365 .