Akut pankreatit ve trombotik trombositopenik purpura birlikteliği: Vaka sunumu

Trombotik trombositopenik purpura nadir görülen bir hastalıkdır. Literatürde, trombotik trombositopenik purpura’nın komplikasyonu olarak akut pankreatit bildirilmiştir. Bu yazıda, karın ağrısı ile acil polikliniğe başvuran, klinik, radyolojik ve biyokimyasal bulgular ile akut pankreatit tanısı alan ve takip sırasında nörolojik bulguların eklenmesi ile trombotik trombositopenik purpura tanısı konulan bir hasta sunuldu. Destek tedavi ve plazmaferez ile klinik semptomlar ve trombotik trombositopenik purpura düzeldi.

Acute pancreatitis and thrombotic thrombocytopenic purpura: Case report

Thrombotic thrombocytopenic purpura is a very rare disease. In the literature, pancreatitis has been reported as a complication of thrombotic thrombocytopenic purpura. We describe a patient who admitted to emergency service complaining of abdominal pain and diagnosed with thrombotic thrombocytopenic purpura by additional neurological symptoms during the follow-up period. He was diagnosed as thrombotic thrombocytopenic purpura and acute pancreatitis with clinical, radiological and laboratory findings. Supportive therapy and plasmapheresis resulted in clinical improvement and resolution of thrombotic thrombocytopenic purpura.

Kaynakça

1. Moschcowitz E. Hyaline thrombosis of the terminal arterioles and capillaries. A hitherto undescribed disease. P Y Pathol Soc 1924; 24: 21.

2. Amorosi EL, Ultmann JE. Thrombotic thrombocytopenic purpura: report of 16 cases and review of the literature. Medicine (Baltimore) 1966; 45: 139-159.

3. Neame PB. Immunologic and other factors in thrombotic thrombocytopenic purpura (TTP). Semin Thromb Hemost 1980; 6:416-29.

4. Singh R, Saunders B, Scopelitis E. Pancreatitis leading to thrombotic thrombocytopenic purpura in systemic lupus erythematosus: a case report and review of literature. Lupus 2003; 12(2): 136-9.

5. Kapur A, Ballou SP, Renston JP, et al. Recurrent acute scleroderma renal crisis complicated by thrombotic thrombocytopenic purpura. J Rheumatol 1997; 24(12): 2469-72.

6. Kfoury Baz EM, Mahfouz RA, Masri AF. Thrombotic thrombocytopenic purpura in a patient with rheumatoid arthritis treated by plasmapheresis. Ther Apher 1999; 3(4): 314-16.

7. Şahin F, Küçükzeybek Y, Saydam G, ve ark. Trombotik trombositopenik purpura seyrinde akut akalkülöz kolesistit: vaka bildirimi. Akademik Gastroenteroloji Dergisi 2003; 2(2): 93-5.

8. Hakala T, Nuutinen PJ, Ruokonen ET, et al. Microangiopathy in acute acalculous cholecystitis. Br J Surg 1997; 84(9): 1249-52.

9. Muniz AE, Barbee W. Thrombotic thrombocytopenic purpura (TTP) presenting as pancreatitis. J Emerg Med 2003; 24(4): 407-11.

10. Talwalkar JA, Ruymann FW, Marcoux P, et al. Recurrent thrombotic thrombocytopenic purpura (TTP) as a complication of acute relapsing pancreatitis. Dig Dis Sci 2002; 47(5): 1096-9.

11. Daryanani S, Wilde JT. Relapsing thrombotic thrombocytopenic purpura in association with recurrent pancreatitis. Clin Lab Haematol 1998; 20(5): 317-8.

12. Varadarajulu S, Ramsey WH, Israel RH. Thrombotic thrombocytopenic purpura in acute pancreatitis. Clin Gastroenterol 2000; 31(3): 243-5.

13. Garcia-Cano J, Vazquez Rodriguez de Alba J, Garcia Cabezas J, et al. Acute pancreatitis in thrombotic thrombocytopenic purpura. An Med Interna 1992; 9(11): 551-3.

14. Vergara M, Modolell I, Puig-Divi V, et al. Acute pancreatitis as a triggering factor for thrombotic thrombocytopenic purpura. Am J Gastroenterol 1998; 93(11): 2215-18.

15. Raife TJ. Pathogenesis of thrombotic thrombocytopenic purpura. Curr Hematol Rep 2003; 2(2): 133-8.

16. Moake JL. Thrombotic microangiopathies. N Eng J Med 2002; 347(8): 589-600.

17. Moake JL, Rudy CK, Troll JH, et al. Unusually large plasma factor VIII: von Willebrand factor multimers in chronic relapsing thrombotic thrombocytopenic purpura. N Eng J Med 1982; 307: 1432-35.

18. Tandon NN, Rock G, Jamieson GA. Anti-CD36 antibodies in thrombotic thrombocytopenic purpura. Br J Haematol 1994; 88: 816-25.

19. Yarranton H, Machin SJ. An update on the pathogenesis and management of acquired thrombotic thrombocytopenic purpura. Curr Opin Neurol 2003; 16(3): 367-73.

20. Agerwal N, Pitchumoni CS. Acute pancreatitis: A multisystemic disesase. Gastroenterologist 1993; 1: 115-28.

21. Vaquero E, Casellas F, Bisbe V, et al. Thrombocytopenia onset in acute episodes of pancreatitis. Med Clin (Barc) 1995; 105(9): 334-7.

22. Chen CC, Wang SS, Chao Y, et al. C-reactive protein and lactate dehydrogenase isoenzymes in the assessment of the prognosis of acute pancreatitis. J Gastroenterol Hepatol 1992; 7(4): 363-6.

23. Bunn HF, Rosse W. Hemolytic anemia and acute blood loss. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, Editors. Principles of Internal Medicine. Volume 1, 15 th ed. New-York. McGraw-Hill 2001; 681-92.

24. Gullo L, Cavichhi L, Tomassetti P, et al. Effects of ischemia on the human pancreas. Gastroenterology 1996; 111: 1033-38.

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