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A Diagnostic and Therapeutic Challenge in Thrombotic Thrombocytopenic Purpura Masked as Pancreatitis: A Case Report from a Facility Lacking Immediate Plasmapheresis Access

Presenting Author Academic/Professional Position

Bharat Peddinani

Academic Level (Author 1)

Resident

Discipline/Specialty (Author 1)

Internal Medicine

Discipline Track

Patient Care

Abstract Type

Case Report

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy requiring urgent plasma exchange for survival. Diagnostic delays and lack of immediate access to plasmapheresis significantly increase morbidity and mortality. This report describes an unusual presentation of TTP initially presented as acute pancreatitis and the management challenges in a facility without plasmapheresis capability.

A 73-year-old woman with hypertension and hyperlipidemia presented with severe abdominal pain, nausea, and vomiting. Laboratory evaluation revealed profound thrombocytopenia (platelets 4,000/µL), anemia, elevated creatinine, and lipase of 2663 U/L. Abdominal imaging demonstrated pancreatic edema, leading to an initial diagnosis of pancreatitis. Despite supportive care, the patient developed neurological deterioration and respiratory failure requiring intubation. Further workup revealed schistocytes, elevated lactate dehydrogenase, and indirect hyperbilirubinemia, consistent with TTP. In the absence of plasmapheresis at the initial facility, high-dose corticosteroids were administered as bridging therapy, resulting in transient improvement. She was transferred to a tertiary center for urgent plasma exchange and immunosuppressive therapy (rituximab), leading to hematologic recovery. ADAMTS13 activity was confirmed to be severely reduced (< 5%).

This case illustrates how TTP can mimic pancreatitis, leading to diagnostic delays and worsening clinical outcomes, particularly in facilities lacking definitive therapy. Early recognition, prompt initiation of bridging therapy, and rapid transfer for plasma exchange remain essential for survival. Improving access to diagnostic testing and therapeutic interventions in community hospitals is critical to reduce disparities in TTP care. Focus on bridging therapies should be a goal to promote better outcomes.

Presentation Type

Poster

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A Diagnostic and Therapeutic Challenge in Thrombotic Thrombocytopenic Purpura Masked as Pancreatitis: A Case Report from a Facility Lacking Immediate Plasmapheresis Access

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy requiring urgent plasma exchange for survival. Diagnostic delays and lack of immediate access to plasmapheresis significantly increase morbidity and mortality. This report describes an unusual presentation of TTP initially presented as acute pancreatitis and the management challenges in a facility without plasmapheresis capability.

A 73-year-old woman with hypertension and hyperlipidemia presented with severe abdominal pain, nausea, and vomiting. Laboratory evaluation revealed profound thrombocytopenia (platelets 4,000/µL), anemia, elevated creatinine, and lipase of 2663 U/L. Abdominal imaging demonstrated pancreatic edema, leading to an initial diagnosis of pancreatitis. Despite supportive care, the patient developed neurological deterioration and respiratory failure requiring intubation. Further workup revealed schistocytes, elevated lactate dehydrogenase, and indirect hyperbilirubinemia, consistent with TTP. In the absence of plasmapheresis at the initial facility, high-dose corticosteroids were administered as bridging therapy, resulting in transient improvement. She was transferred to a tertiary center for urgent plasma exchange and immunosuppressive therapy (rituximab), leading to hematologic recovery. ADAMTS13 activity was confirmed to be severely reduced (< 5%).

This case illustrates how TTP can mimic pancreatitis, leading to diagnostic delays and worsening clinical outcomes, particularly in facilities lacking definitive therapy. Early recognition, prompt initiation of bridging therapy, and rapid transfer for plasma exchange remain essential for survival. Improving access to diagnostic testing and therapeutic interventions in community hospitals is critical to reduce disparities in TTP care. Focus on bridging therapies should be a goal to promote better outcomes.