A Case of Thrombotic Thrombocytopenic Purpura and ST-Elevation Myocardial Infarction: An Unusual Correlation

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially devastating blood disorder depicted by thrombocytopenia, fever, widespread small vessel hemolytic anemia, and neurological symptoms. The involvement of the renal and neurological systems is frequently reported in TTP; however, TTP-induced acute coronary syndrome is not widely reported. We describe a case of myocardial infarction induced by TTP in a patient who presented with the typical manifestation of acute coronary syndrome. Echocardiogram revealed a myocardial injury, and detailed investigations revealed increased levels of troponin I, lactate dehydrogenase, diminished levels of haptoglobin and von Willebrand factor-cleaving protease, and schistocytes on peripheral smear, suggestive of TTP-induced myocardial infarction. His condition was stabilized after commencing plasmapheresis, steroids, and rituximab. The initial steps in the management of this patient involve the prompt administration of steroids and the urgent start of plasmapheresis to increase platelet count.

Keywords: acquired ttp; acute coronary syndrome; acute thrombotic microangiopathy; myocardial infarction; thrombotic thrombocytopenic purpura; ttp.

Figure 1. Electrocardiograph demonstrating ST-segment elevation in leads 2, 3, and aVF with reciprocal changes in the aVL lead

aVF- Augmented vector Foot; aVL- Augmented vector Left

Figure 2. Trend of platelet count and serum creatinine during the hospital stay