Treatment of severe, refractory and rapidly evolving thrombotic thrombocytopenic purpura.
A 36-year-old man presented to hospital with gross haematuria and evidence of severe, refractory thrombotic thrombocytopenic purpura. Initial treatment with high-volume plasma exchange therapy and early administration of rituximab failed to achieve a sustained clinical response. His clinical course was complicated by left hemianopsia and despite an urgent splenectomy he developed a large right-sided stroke with malignant cerebral oedema that required an emergent decompressive craniotomy. He also had numerous infectious complications as a consequence of an aggressive immunosuppressive strategy. While the patient did not respond to cyclophosphamide, cyclosporine, N-acetylcysteine, and one course of bortezomib, he eventually responded to a second course of bortezomib. One year later, the patient remains in remission and maintains excellent cognitive function. However, he has not completely recovered from his stroke and continues to participate in rehabilitation for his residual physical deficits.
Department of Medicine, Division of Nephrology, London Health Sciences Centre, London, Canada.
Rey R
http://orcid.org/0000-0002-5612-2328
RR
Acedillo
Department of Medicine, Division of Nephrology, London Health Sciences Centre, London, Canada.
Mayur
M
Govind
Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Abdullah
A
Kashgary
Department of Medicine, Division of Nephrology, London Health Sciences Centre, London, Canada.
William F
WF
Clark
D000328:Adult; D000069286:Bortezomib / Q000627:therapeutic use*; D001929:Brain Edema / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
D000069286:Bortezomib