Influenza A infection triggers thrombotic thrombocytopenic purpura by producing the anti-ADAMTS13 IgG inhibitor.
A 68-year-old Japanese woman infected with influenza A developed thrombotic thrombocytopenic purpura (TTP) 2 days after having a fever. Routine laboratory tests on admission suggested a diagnosis of disseminated intravascular coagulation. However, ADAMTS13 assays showed an extremely low level of plasma ADAMTS13 activity with a high titer of anti-ADAMTS13 inhibitor (IgG). Despite high-dose methylprednisolone therapy with daily plasma exchange for 3 consecutive days, the patient died of pulmonary congestion complicated by cardiac failure. Our experience here provides the first evidence that influenza A infection is sufficient to trigger TTP by producing the anti-ADAMTS13 IgG inhibitor.
Kosugi
Nobuharu
N
Department of Internal Medicine, Numazu City Hospital, Numazu.
Tsurutani
Yuya
Y
Isonishi
Ayami
A
Hori
Yuji
Y
Matsumoto
Masanori
M
Fujimura
Yoshihiro
Y
D051722:ADAM Proteins / Q000037:antagonists & inhibitors* / Q000097:blood / Q000276:immunology; D000071120:ADAMTS13 Protein; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000097:blood / Q000276:immunology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D009980:Influenza A virus; D007251:Influenza, Human / Q000097:blood / Q000150:complications* / Q000276:immunology; D011697:Purpura, Thrombotic Thrombocytopenic / Q000097:blood / Q000209:etiology* / Q000276:immunology
D000888:Antibodies, Anti-Idiotypic; D007074:Immunoglobulin G; C048844:anti-IgG; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human