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Thrombotic microangiopathy associated with Mycoplasma pneumoniae infection
Filipa Caeiro Alves1, Rute Aguiar1, Pedro Pessegueiro1
1Department of Nephrology, Hospital do Espirito Santo de Évora EPE, Évora, Portugal.
Abstract:
Thrombotic microangiopathy (TMA) comprises a process of sequential endothelial damage, microvascular thrombosis, consumptive thrombocytopenia and microangiopathic haemolytic anaemia that can affect several organs, including the kidney. A 36-year-old woman was presented with a petechial rash 3 weeks after an upper respiratory tract infection. Laboratory results showed normocytic normochromic anaemia, thrombocytopenia and evidence of TMA with decreased haptoglobin, elevated serum lactate dehydrogenase and a peripheral blood smear with numerous schistocytes. Treatment included daily plasmapheresis and prednisolone, with favourable clinical evolution. Antibodies anti-ADAMTS13 were positive, establishing the diagnosis of acquired thrombotic thrombocytopenic purpura. There was also serological evidence of a recent infection by Mycoplasma pneumoniae, and therefore the preceding respiratory tract infection by this agent was the most likely trigger for the disease. Due to the high mortality rate and poor outcomes, the prompt diagnostic and treatment are crucial in this rare disease. The identification of triggers related to this pathology can allow new therapeutic targets or preventive strategies.
Insights
A rare thrombotic microangiopathy (TMA), thrombotic thrombocytopenic purpura (TTP), was diagnosed in a woman following a respiratory infection. Prompt treatment with plasmapheresis and steroids led to recovery, highlighting the importance of early diagnosis and intervention.
Area of Science:
- Hematology
- Nephrology
- Infectious Disease
Background:
- Thrombotic microangiopathy (TMA) is a serious condition involving endothelial damage and microvascular thrombosis.
- It can lead to organ damage, particularly in the kidneys, and is characterized by low platelets and red blood cell destruction.
Observation:
- A 36-year-old woman presented with a rash and symptoms of TMA after an upper respiratory infection.
- Lab results confirmed TMA, including anemia, thrombocytopenia, schistocytes, and elevated LDH.
- The patient developed antibodies against ADAMTS13, indicating acquired thrombotic thrombocytopenic purpura (TTP).
Findings:
- The patient's TTP was triggered by a Mycoplasma pneumoniae infection.
- Treatment with daily plasmapheresis and prednisolone resulted in a favorable clinical outcome.
- Positive anti-ADAMTS13 antibodies confirmed the diagnosis of acquired TTP.
Implications:
- Prompt diagnosis and treatment are critical for improving outcomes in TTP, a rare disease with high mortality.
- Identifying infection triggers, such as Mycoplasma pneumoniae, may lead to new therapeutic or preventive strategies for TTP.
- This case underscores the link between infections and the development of thrombotic microangiopathies.
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