title: Postendoscopic retrograde cholangiopancreatography pancreatitis: a rare cause of thrombotic thrombocytopenic purpura-hemolytic uremic syndrome.
abstract: Endothelial injury is perhaps the inciting factor leading to the microangiopathic process that initiates thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS). TTP-HUS after postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is extremely rare, but potentially is life threatening. Here, we describe a case of a 23-year-old man with a history of choledocholithiasis, who developed TTP-HUS, 2 days after the onset of post-ERCP pancreatitis. It is important that physicians recognize TTP-HUS as one of the potential causes of acute kidney injury in cases of acute pancreatitis and post-ERCP pancreatitis for adult patients, especially when there is concomitant thrombocytopenia and hemolytic anemia. The early initiation of plasma exchange has a major impact on the survival and preservation of renal function. Exchange transfusion of fresh frozen plasma remains the cornerstone treatment of TTP-HUS.
authors.affiliation: II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany. Petia.Jeliazkova@lrz.tu-muenchen.de
authors.forename: Petia
authors.initials: P
authors.lastname: Jeliazkova
authors.forename: Sebastian
authors.initials: S
authors.lastname: Noe
authors.forename: Philipp
authors.initials: P
authors.lastname: Jost
authors.forename: Oliver
authors.initials: O
authors.lastname: Sarkar
authors.forename: Claudius
authors.initials: C
authors.lastname: Küchle
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.forename: Fabian
authors.initials: F
authors.lastname: Geisler
mesh_terms: D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D042883:Choledocholithiasis / Q000601:surgery; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology*; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000150:complications*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000209:etiology*; D055815:Young Adult