title: A case of thrombotic thrombocytopenic purpura associated with bupropion.
abstract: OBJECTIVE
  To report a case of bupropion-associated thrombotic thrombocytopenic purpura (TTP) syndrome.
  
  
  METHODS
  A 55-year-old man was admitted with complaints of diarrhea, acute renal failure, and confusion ~ 54 days after bupropion initiation for smoking cessation. Subsequently he had a tonic-clonic seizure and had to be intubated because of altered consciousness. Laboratory findings were compatible with microangiopathic hemolytic anemia. He was diagnosed as TTP for which the Naranjo adverse drug reaction probability scale indicated a probable relationship with bupropion (a score of 5). He was treated with plasma exchange, systemic corticosteroids, hemodialysis and recovered fully.
  
  
  CONCLUSIONS
  Bupropion is an anti-depressant drug also indicated for smoking cessation. It has widely reported neuropsychiatric and allergic adverse effects; however, TTP associated with bupropion has only been reported once. The clinical course of TTP in this case was compatible with TTP related to acute, immune mediated drug toxicity, which suggests that auto-antibodies might have been responsible.
  
  
  CONCLUSIONS
  Given the fact that the clinical condition is compatible with acute, immune-mediated TTP syndrome, we suggest bupropion deserves evaluation for auto-antibody induction. Prescribers should be aware of the possible risk of thrombocytopenia and TTP.
authors: Ankara Ataturk Training and Research Hospital, Ankara, Turkey. defne98hac@yahoo.com
authors: Neriman Defne
authors: ND
authors: Altintas
authors: Seval
authors: S
authors: Izdes
authors: Sibel
authors: S
authors: Yucel
authors: Murat
authors: M
authors: Suher
authors: Imdat
authors: I
authors: Dilek
mesh_terms: D051722:ADAM Proteins / Q000172:deficiency; D000071120:ADAMTS13 Protein; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects*; D016642:Bupropion / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human