Dengue Virus Infection Triggering Thrombotic Thrombocytopenic Purpura in Pregnancy.
We report a case of thrombotic thrombocytopenic purpura (TTP) that immediately followed symptomatic dengue virus infection in a pregnant lady. The patient developed dengue fever at 16 weeks of gestation, resulting in spontaneous abortion. Subsequently, fever reappeared with persistent thrombocytopenia and jaundice. Investigations revealed microangiopathic hemolysis; there was no evidence of disseminated intravascular coagulation. The TTP episode resolved after six cycles of therapeutic plasma exchange with fresh-frozen plasma. An ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif 13 repeats) activity assay, done during convalescence, showed normal activity. The patient had an uneventful second pregnancy and has remained free of TTP recurrence for more than 2 years now. We review the pathophysiological basis of TTP in dengue infection, and suggest that jaundice with disproportionate elevation of serum aspartate aminotransferase level in a patient with dengue should arouse the suspicion of TTP.
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Surendran
S
Deepanjali
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Raghuramulu R
RR
Naik
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Sharada
S
Mailankody
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Sivamani
S
Kalaimani
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India kadhir@jipmer.edu.in.
Tamilarasu
T
Kadhiravan
D051722:ADAM Proteins / Q000378:metabolism; D000071120:ADAMTS13 Protein; D000022:Abortion, Spontaneous / Q000209:etiology*; D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D003715:Dengue / Q000150:complications* / Q000821:virology; D003716:Dengue Virus / Q000302:isolation & purification; D004211:Disseminated Intravascular Coagulation; D005260:Female; D006801:Humans; D007565:Jaundice / Q000209:etiology; D010951:Plasma Exchange; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000209:etiology*; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000821:virology*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000097:blood / Q000209:etiology*
D001219:Aspartate Aminotransferases; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human