title: Hemorrhagic Stroke in an Adolescent Female with HIV-Associated Thrombotic Thrombocytopenic Purpura.
abstract: HIV-1 infection can trigger acute episodes of Idiopathic Thrombocytoponic Purpura (ITP), and Thrombotic Thrombocytopenic Purpura (TTP), particularly in populations with advanced disease and poor adherence to antiretroviral therapy (ART). These diseases should be distinguished because they respond to different treatments. Previous studies done in adults with HIV-TTP have recommended the prompt initiation or re-initiation of ART in parallel with plasma exchange therapy to improve the clinical outcome of these patients. Here, we describe a case of HIV-TTP resulting in an acute hemorrhagic stroke in a 16 year old female with perinatally acquired HIV infection and non-adherence to ART, who presented with severe thrombocytopenia, microangiopathic hemolytic anemia, and a past medical history of HIV-ITP. Both differential diagnosis and treatments for HIV-ITP and HIV-TTP were considered simultaneously. A decrease in plasma ADAMTS13 activity (<5%) without detectable inhibitory antibodies confirmed the diagnosis of HIV-TTP. Re-initiation of ART and plasma exchange resulted in a marked decrease in the HIV-RNA viral load, recovery of the platelet count, and complete recovery was achieved with sustained virologic suppression.
authors.affiliation: Divisions of Infectious Disease, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA ; Department of Pediatrics, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA.
authors.forename: Natella
authors.initials: N
authors.lastname: Rakhmanina
authors.affiliation: Laboratory Medicine, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA ; Department of Pediatrics, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA ; The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA.
authors.forename: Edward Cc
authors.initials: EC
authors.lastname: Wong
authors.affiliation: Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle WA, USA.
authors.forename: Jeremiah C
authors.initials: JC
authors.lastname: Davis
authors.affiliation: Children's National Medical Center, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA ; Department of Pediatrics, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA.
authors.forename: Patricio E
authors.initials: PE
authors.lastname: Ray
keywords: Antiretroviral therapy; HIV-HUS; HIV-ITP; HIV-TTP; Hemorrhagic stroke; Immune thrombocytopenic purpura; Microangiopathic hemolytic anemia; Plasma exchange