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Dengue Virus Infection Triggering Thrombotic Thrombocytopenic Purpura in Pregnancy

Surendran Deepanjali1, Raghuramulu R Naik1, Sharada Mailankody1

  • 1Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

The American Journal of Tropical Medicine and Hygiene
|August 19, 2015
PubMed

We report a case of thrombotic thrombocytopenic purpura (TTP) that immediately followed symptomatic dengue virus infection in a pregnant lady. The patient developed dengue fever at 16 weeks of gestation, resulting in spontaneous abortion. Subsequently, fever reappeared with persistent thrombocytopenia and jaundice. Investigations revealed microangiopathic hemolysis; there was no evidence of disseminated intravascular coagulation. The TTP episode resolved after six cycles of therapeutic plasma exchange with fresh-frozen plasma. An ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif 13 repeats) activity assay, done during convalescence, showed normal activity. The patient had an uneventful second pregnancy and has remained free of TTP recurrence for more than 2 years now. We review the pathophysiological basis of TTP in dengue infection, and suggest that jaundice with disproportionate elevation of serum aspartate aminotransferase level in a patient with dengue should arouse the suspicion of TTP.

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