Scleromyxoedema and thrombotic thrombocytopaenic purpura: two rare conditions both responding to plasma exchange.
We report the case of a 66-year-old female who over an 18-month period developed severe, disabling scleromyxoedema with pulmonary fibrosis. Treatment with oral prednisolone and melphalan had failed to prevent disease progression. Treatment with a 5-day course of plasma exchange, intravenous cyclophosphamide (500 mg) and methyl-prednisolone (1 g on 3 consecutive days) was unfortunately followed by the development of thrombotic thrombocytopaenic purpura (TTP). After 17 extra plasma exchanges, she recovered and there has been a dramatic improvement in her skin signs. We postulate that the extra plasma exchanges which she received as a consequence of developing TTP have contributed to this result. To our knowledge, TTP has never been associated with scleromyxoedema, but it is likely to be a coincidence in this case.
Harman
K E
KE
St. John's Institute of Dermatology, St. Thomas' Hospital, London, UK. k.harman@umds.ac.uk
Abbs
I C
IC
Mahood
J M
JM
Black
M M
MM
D000368:Aged; D005260:Female; D006801:Humans; D010951:Plasma Exchange; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000473:pathology / Q000628:therapy; D012595:Scleroderma, Systemic / Q000150:complications* / Q000473:pathology / Q000628:therapy