title: Clopidogrel-induced refractory thrombotic thrombocytopenic purpura successfully treated with rituximab.
abstract: Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder characterized by microvascular aggregation of platelets and fibrin strands causing thrombocytopenia, microangiopathic hemolytic anemia, and organ dysfunction. TTP can develop as a result of a deficiency in ADAMTS13 enzyme activity due to either a genetic defect or, more commonly, the development of anti-ADAMTS13 autoantibodies. TTP can also be associated with pregnancy, organ transplant, lupus, infections, and drugs. Here, we present a case of TTP that developed shortly after the start of clopidogrel treatment for acute ischemic stroke and acute myocardial infarction, and describe the clinical presentation, refractory course of the disease, and successful induction of remission through the use of rituximab in a setting of pre-existing autoimmune diseases.
authors.affiliation: Charles E. Schmidt College of Medicine, Boca Raton, FL, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Khodor
authors.affiliation: Department of Internal Medicine, Cleveland Clinic-Florida, Weston, FL, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Castro
authors.affiliation: Charles E. Schmidt College of Medicine, Boca Raton, FL, USA.
authors.forename: Colin
authors.initials: C
authors.lastname: McNamara
authors.affiliation: Taussig Cancer Institute of the Cleveland Clinic, Maroone Cancer Center, Cleveland Clinic-Florida, Weston, FL, USA. Electronic address: chaulac@ccf.org.
authors.forename: Chakra P
authors.initials: CP
authors.lastname: Chaulagain
mesh_terms: D000071120:ADAMTS13 Protein / Q000378:metabolism; D000328:Adult; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D010976:Platelet Count; D011697:Purpura, Thrombotic Thrombocytopenic / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy*; D000069283:Rituximab / Q000627:therapeutic use*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000069283:Rituximab; D000077144:Clopidogrel; D007770:L-Lactate Dehydrogenase; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human; D013988:Ticlopidine
keywords: ADAMTS13; Clopidogrel; Hemolytic uremic syndrome; Rituximab; Thrombotic thrombocytopenic purpura