title: Acute pancreatitis-induced thrombotic thrombocytopenic purpura with recurrent acute pancreatitis.
abstract: Recent successive reports on acute pancreatitis-induced thrombotic thrombocytopenic purpura (TTP) have revealed that TTP-related microvascular damage is an aggravating factor of acute pancreatitis. Here, we report the case of a 26-year-old man diagnosed with acute pancreatitis due to high alcohol consumption. The patient was unconscious as he had taken an overdose of medication, and presented with fever and renal failure due to acute pancreatitis on admission. Although the pancreatitis subsequently improved, the symptoms were still observed; on the next day, he exhibited hemoglobinuria, anemia, and thrombocytopenia. Moreover, general blood examinations indicated the presence of schistocytes and reduced activity of ADAMTS13 (a disintegrin-like metalloproteinase with thrombospondin type 1 motif 13) to 47 %. Thus, the patient was diagnosed with TTP, and plasma exchange was performed. After the development of TTP, the acute pancreatitis recurred, but a severe pathogenesis was prevented by plasma exchange. Thus, ADAMTS13 activity may be useful for predicting a severe pathogenesis of acute pancreatitis. In ADAMTS13-deficient cases, plasma exchange may be an effective technique for preventing aggravation of acute pancreatitis.
authors.affiliation: Department of Critical Care Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan. yfujino-gi@umin.ac.jp.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujino
authors.affiliation: Department of Critical Care Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of Critical Care Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Onodera
authors.affiliation: Department of Critical Care Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kikuchi
authors.affiliation: Department of Critical Care Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Critical Care Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kojika
authors.affiliation: Department of Critical Care Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Hisaho
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Laboratory Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
authors.forename: Keijiro
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Blood Transfusion Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8521, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D051722:ADAM Proteins / Q000172:deficiency; D000208:Acute Disease; D000328:Adult; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000150:complications* / Q000201:enzymology; D010951:Plasma Exchange; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications* / Q000201:enzymology / Q000628:therapy; D012008:Recurrence
chemical_list: D051722:ADAM Proteins
keywords: ADAMTS13 protein; Pancreatitis; Plasma exchange; TTP