A Case of Thrombotic Thrombocytopenic Purpura, likely triggered by Deep Vein Thrombosis

Fifty six year old male presented with a sudden, tender swelling of his right leg. A diagnosis of femoral vein thrombosis was made because of typical purple skin color and palpable thrombosed femoral vein with intact arterial flow and then anticoagulant and fibrinolytic therapy was initiated. Subsequently, he suffered from disorientation, spiking fever, thrombocytopenia, hemolytic anemia and renal failure, all of which were compatible with thrombotic thrombocytopenic purpura (TTP). As the swelling of the leg subsided, the entire skin of the leg became gangrenous in spite of the satistactory arterial circulation, which necessitated above knee amputation. Medical treatment consisted of corticosteroid, protease inhibitor and gamma globlin resulted in rapid improvement in all the clinical manifestations of TTP. Histological examination of the amputated of leg revealed the presence of multiple thrombotic occlusion of arterioles in calf muscles, which is compatible with changes in TTP. In this case, TTP was more likely triggered by the deep vein thrombosis, which has not been reported before as the underlying disease of TTP. Arteriole thrombosis was formed because of the stagnant venous drainage, which is also rare sequelae of TTP.