[Rapid exacerbation of thrombotic microangiopathy accompanied by electrocardiogram abnormality leading to death]

A 73-year-old female was hospitalized with thrombotic microangiopathy (TMA) diagnosis because of consciousness disturbance, anemia, thrombocytopenia, renal dysfunction, and electrocardiogram abnormality. The patient died on day 12 of the symptom onset. The immunohistochemical analysis of microclot found in the autopsy of coronary artery confirmed TMA. It was suggested that the relationship to collagen disease by antinuclear antibody positive and the necessity of initiating circulation management and plasma exchange immediately before approximately 1×10⁴ of platelets for the prognosis. The findings suggested considering TMA at the time of an unidentified shock, particularly acute adrenal insufficiency.