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A case off TTP temporally associated with cocaine use: Implications for treatment of suspected DITMA.
J Clin Apher. 2019 Aug; 34(4):510-512.JC

Abstract

Thrombotic microangiopathies are rare diseases associated with significant morbidity and mortality. The treatment of thrombotic thrombocytopenic purpura (TTP) and drug-induced thrombotic microangiopathy (DITMA) remains a diagnostic dilemma as they present similarly but respond differently to standard treatment with plasma exchange. TTP is a deficiency of a disintegrin and metalloprotease with thrombospondin type 1 motif 13 resulting in von Willebrand factor aggregates. DITMA is due to vascular and platelet toxicity. Our case contradicts a notion in current literature that suggests supportive therapy when there is high suspicion for DITMA. We present what appears to be the second published case of cocaine temporally associated with TTP. Our case responded to therapy. We propose this case should influence weighing the risks and benefits of treatment of suspected DITMA and reinforces current official guidelines that suggest treating cases of suspected DITMA as TTP until the diagnosis is confirmed.

Authors+Show Affiliations

Department of Medicine, West Virginia University Hospital, Morgantown, West Virginia.Department of Medicine, West Virginia University Hospital, Morgantown, West Virginia.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

30776151

Citation

Regner, Sean R., and Nathan Lerfald. "A Case Off TTP Temporally Associated With Cocaine Use: Implications for Treatment of Suspected DITMA." Journal of Clinical Apheresis, vol. 34, no. 4, 2019, pp. 510-512.
Regner SR, Lerfald N. A case off TTP temporally associated with cocaine use: Implications for treatment of suspected DITMA. J Clin Apher. 2019;34(4):510-512.
Regner, S. R., & Lerfald, N. (2019). A case off TTP temporally associated with cocaine use: Implications for treatment of suspected DITMA. Journal of Clinical Apheresis, 34(4), 510-512. https://doi.org/10.1002/jca.21687
Regner SR, Lerfald N. A Case Off TTP Temporally Associated With Cocaine Use: Implications for Treatment of Suspected DITMA. J Clin Apher. 2019;34(4):510-512. PubMed PMID: 30776151.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A case off TTP temporally associated with cocaine use: Implications for treatment of suspected DITMA. AU - Regner,Sean R, AU - Lerfald,Nathan, Y1 - 2019/02/18/ PY - 2018/08/06/received PY - 2019/01/17/revised PY - 2019/01/18/accepted PY - 2019/2/19/pubmed PY - 2020/1/16/medline PY - 2019/2/19/entrez KW - ADAMTS13 KW - cocaine KW - drug induced microangiopathic hemolytic anemia KW - plasma exchange KW - thrombotic thrombocytopenic purpura SP - 510 EP - 512 JF - Journal of clinical apheresis JO - J Clin Apher VL - 34 IS - 4 N2 - Thrombotic microangiopathies are rare diseases associated with significant morbidity and mortality. The treatment of thrombotic thrombocytopenic purpura (TTP) and drug-induced thrombotic microangiopathy (DITMA) remains a diagnostic dilemma as they present similarly but respond differently to standard treatment with plasma exchange. TTP is a deficiency of a disintegrin and metalloprotease with thrombospondin type 1 motif 13 resulting in von Willebrand factor aggregates. DITMA is due to vascular and platelet toxicity. Our case contradicts a notion in current literature that suggests supportive therapy when there is high suspicion for DITMA. We present what appears to be the second published case of cocaine temporally associated with TTP. Our case responded to therapy. We propose this case should influence weighing the risks and benefits of treatment of suspected DITMA and reinforces current official guidelines that suggest treating cases of suspected DITMA as TTP until the diagnosis is confirmed. SN - 1098-1101 UR - https://www.unboundmedicine.com/medline/citation/30776151/A_case_off_TTP_temporally_associated_with_cocaine_use:_Implications_for_treatment_of_suspected_DITMA_ L2 - https://doi.org/10.1002/jca.21687 DB - PRIME DP - Unbound Medicine ER -