title: Recurrent idiopathic thrombotic thrombocytopenic purpura: a role for vaccination in disease relapse?
abstract: The presence of antibodies against a disintegrin-like metalloproteinase with thrombospondin type 1 motif, isoform 13 (ADAMTS 13 protease) is the main cause (70% to 80%) of idiopathic and recurrent thrombotic thrombocytopenic purpura (TTP). However, etiologic factors that trigger the onset and potential relapses of TTP remain unclear. Immunologic deregulation and infectious agents are suspected. We report the case of a 51-year-old white man presenting with idiopathic TTP caused by autoantibodies against ADAMTS 13 protease. The first acute TTP episode needed long-term plasma exchanges because of early relapses. Consequently, vincristine therapy and splenectomy were performed. Those treatments induced TTP remission for 18 months. Relapses occurred twice between 1 and 3 months after vaccination. However, those relapses were not as severe as the first acute episode and responded to short-course plasma exchanges. ADAMTS 13 antibodies and decreased ADAMTS 13 protease activity were searched for and detected first during the second relapse. This case challenges the role of vaccination as an etiologic factor in the recurrence of idiopathic TTP.
authors.affiliation: Hospices Civils de Lyon et Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Albane
authors.initials: A
authors.lastname: Brodin-Sartorius
authors.forename: Fitsum
authors.initials: F
authors.lastname: Guebre-Egziabher
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
authors.forename: Gregoire
authors.initials: G
authors.lastname: Cozon
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Villar
authors.forename: Maurice
authors.initials: M
authors.lastname: Laville
authors.forename: Laurent
authors.initials: L
authors.lastname: Juillard
mesh_terms: D051722:ADAM Proteins / Q000276:immunology*; D000071120:ADAMTS13 Protein; D000917:Antibody Formation; D001323:Autoantibodies; D006801:Humans; D007252:Influenza Vaccines / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000276:immunology* / Q000473:pathology / Q000628:therapy; D012008:Recurrence; D013156:Splenectomy
chemical_list: D001323:Autoantibodies; D007252:Influenza Vaccines; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human