title: Neglect-induced pseudo-thrombotic thrombocytopenic purpura due to vitamin B12 deficiency.
abstract: Although thrombotic thrombocytopenic purpura (TTP) is rare, early diagnosis and treatment are important for decreasing the mortality rate. Acquired vitamin B12 deficiency is frequently overlooked because of its rarity in developed countries, particularly in children and adolescents. The hematological changes in vitamin B12 deficiency present as megaloblastic anemia, increased lactate dehydrogenase, vasoconstriction, increased platelet aggregation, and abnormal activation of the coagulation followed by microangiopathy as well as neutropenia and thrombocytopenia. We report herein the case of a 15-year-old girl who had been neglected, which might have caused pseudo-TTP through malnutrition, particularly vitamin B12 deficiency. When we encounter cases of TTP in children, clinicians must be aware of the possibility of malnutrition, particularly with vitamin B12 deficiency, even in developed countries, and investigate the cause of malnutrition including neglect.
authors.affiliation: Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital, Inzai City, Chiba, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Asano
authors.affiliation: Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital, Inzai City, Chiba, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Narazaki
authors.affiliation: Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital, Inzai City, Chiba, Japan.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Kaizu
authors.affiliation: Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital, Inzai City, Chiba, Japan.
authors.forename: Shouhei
authors.initials: S
authors.lastname: Matsukawa
authors.affiliation: Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital, Inzai City, Chiba, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Takema-Tochikubo
authors.affiliation: Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital, Inzai City, Chiba, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Fujii
authors.affiliation: Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba Hokusoh Hospital, Inzai City, Chiba, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Saitoh
authors.affiliation: Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba Hokusoh Hospital, Inzai City, Chiba, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Mashiko
authors.affiliation: Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital, Inzai City, Chiba, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Fujino
mesh_terms: D000293:Adolescent; D001706:Biopsy; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D044342:Malnutrition / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D058069:Neglected Diseases; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000150:complications*
keywords: neglect; pseudo-thrombotic thrombocytopenic purpura; vitamin B12 deficiency