Thrombotic thrombocytopenic purpura associated with acalculous cholecystitis masquerading as immune thrombocytopenia

Department

Internal Medicine

Additional Department

Oncology and Hematology

Document Type

Article

Publication Title

Blood Coagulation & Fibrinolysis

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a potentially life-threatening condition characterized by thrombocytopenia, microangiopathic haemolytic anaemia, and end-organ ischemia. Association of TTP with acute cholecystitis is rare, with only two cases reported in literature. We report the third case of TTP associated with acute cholecystitis in an African-American female with systemic lupus erythematosus (SLE). She presented with fever and abdominal pain; laboratory testing revealed acute on chronic thrombocytopenia, and imaging confirmed acute acalculous cholecystitis. This initially led to a misdiagnosis of immune thrombocytopenia (ITP), and she was treated with antibiotics, intravenous immunoglobulin, and steroids without improvement. She subsequently developed neurological symptoms with laboratory evidence of haemolysis raising a concern for thrombotic microangiopathy. Emergent plasmapheresis was initiated for suspected TTP, resulting in improvement of her symptoms. Low ADAMTS13 activity subsequently confirmed the diagnosis. This case highlights the importance of recognizing atypical presentations of TTP to initiate prompt life-saving treatment.

First Page

233

Last Page

236

DOI

10.1097/MBC.0000000000001432

Volume

37

Issue

5

Publication Date

7-1-2026

Publisher

Lippincott Williams And Wilkins

Medical Subject Headings

Humans; Purpura, Thrombotic Thrombocytopenic; Female; Purpura, Thrombocytopenic, Idiopathic; Acalculous Cholecystitis; Diagnosis, Differential; ADAMTS13 Protein; Lupus Erythematosus, Systemic; Adult

PubMed ID

42083381

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