title: Staphylococcus aureus bacteremia as a cause of early relapse of thrombotic thrombocytopenic purpura.
abstract: BACKGROUND
  Thrombotic thrombocytopenic purpura (TTP) is a multisystem disease characterized by the sudden onset of hemolytic anemia, thrombocytopenia, fever, renal failure, and neurologic dysfunction, occurring in various combinations. The most effective treatment of TTP is plasma exchange and the administration of corticosteroids, which reduces mortality from the 90 percent seen in untreated patients to 10 percent.
  
  
  METHODS
  Two patients responded favorably to plasma exchange and corticosteroid therapy, but their TTP relapsed during treatment. In both cases, the early relapse of TTP was associated with Staphylococcus aureus bacteremia secondary to central line infection. Treatment of the infection and intensification of the plasma exchange regimen resulted in a sustained remission.
  
  
  CONCLUSIONS
  Infection should be actively sought and treated in TTP patients who are refractory to treatment or in whom an exacerbation of the disease occurs while they are undergoing plasma exchange.
authors.affiliation: Departments of Medicine A and B and the Division of Transfusion Medicine, Meir Hospital, Kfar Saba, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Niv
authors.forename: A
authors.initials: A
authors.lastname: Segev
authors.forename: M H
authors.initials: MH
authors.lastname: Ellis
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000150:complications*; D006801:Humans; D008297:Male; D010951:Plasma Exchange; D011697:Purpura, Thrombotic Thrombocytopenic / Q000209:etiology* / Q000517:prevention & control* / Q000628:therapy; D012008:Recurrence; D013203:Staphylococcal Infections / Q000150:complications*; D013211:Staphylococcus aureus