Thrombotic Thrombocytopenic Purpura Presenting with Acute Neurological Symptoms: A Case Report

Abstract

Thrombotic thrombocytopenic purpura is a rare but life-threatening thrombotic microangiopathy that may present with a wide spectrum of neurological manifestations, often mimicking cerebrovascular events and leading to diagnostic delay. In this case, we aimed to present a patient with thrombotic thrombocytopenic purpura who presented to the emergency department with acute neurological symptoms. A 49-year-old male patient with no known chronic disease was admitted to the emergency department with altered mental status and speech disturbance. Initial neurological evaluation suggested a cerebrovascular event or postictal state; however, brain imaging revealed no ischemic or hemorrhagic pathology. Laboratory evaluation demonstrated anemia and severe thrombocytopenia, and further tests revealed elevated lactate dehydrogenase and indirect bilirubin levels. Peripheral blood smear showed schistocytes, supporting the diagnosis of thrombotic thrombocytopenic purpura. The patient was urgently transferred to a center capable of performing plasma exchange, where plasma exchange therapy and corticosteroid treatment were initiated. Although rapid neurological and hematological improvement was achieved, early relapse occurred shortly after discharge, requiring repeat plasma exchange therapy. This case emphasizes the importance of considering thrombotic thrombocytopenic purpura in patients presenting with acute neurological symptoms and unexplained thrombocytopenia in the emergency department, as early diagnosis and prompt treatment are crucial for reducing morbidity and mortality.