J Korean Rheum Assoc.  2009 Dec;16(4):296-300.

Thrombotic Thrombocytopenic Purpura Induced by Trimethoprim-Sulfamethoxazole in a Patient with Rheumatoid Arthritis

• Sohn JY
• Lee KA
• Hong YK
• Yoo WH

Abstract

Thromobotic thrombocytopenic purpura (TTP) is a multisystem disorder that's characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia,and neurologic symptoms. TTP is associated with many diseases and several therapeutic drugs. We report here on the first Korean case of a patient with rheumatoid arthritis (RA) and who developed TTP that was associated with trimethoprim-sulfamethoxazole (TMP-SMX) in Korea. She recovered from the TTP following daily sessions of therapeutic plasma exchange (TPE) with fresh plasma replacement and glucocorticoid therapy. Awareness of the possible development of TTP in patient with RA and who is being treated with TMP-SMX is important for making the early diagnosis and administering proper treatment.

Keyword

Thrombotic thrombocytopenic purpura; Rheumatoid arthritis; Trimethoprim-Sulfamethoxazole; Therapeutic plasma exchange; Glucocorticoidx

MeSH Terms

Arthritis, Rheumatoid
Early Diagnosis
Humans
Korea
Neurologic Manifestations
Plasma
Plasma Exchange
Purpura, Thrombocytopenic
Purpura, Thrombotic Thrombocytopenic
Thrombocytopenia
Thymine Nucleotides
Trimethoprim, Sulfamethoxazole Drug Combination
Thymine Nucleotides

Figure

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  Fig. 1. Overall, this X-ray shows an irregular ground glass appearance in both lung fields, and this aspect is prominent on the upper lung fields.

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  Fig. 2. The HRCT shows consolidations and ground glass opacities in both lung fields, and this it appears with a sparing patterns at the subpleural regions.

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  Fig. 3. After 4 days treatment with TMP-SMX, the X-ray shows markedly improved findings.

Reference

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