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A rare case of malignant hypertension with splenic rupture and thrombotic microangiopathy: A case report
JiaXiang Ding1, Zhen Qu1, Feng Yu1,2
1Renal Division, Department of Medicine, Peking University International Hospital.
Introduction:
Thrombotic microangiopathy (TMA) is characterized by endothelial injury followed by formation of multiple microthrombi in the target organs due to various causes, including malignant hypertension (MHT). Here, we reported a rare case of MHT with splenic TMA changes.
Case Concerns:
A 27-year-old Chinese Han male with a history of hypertension and proteinuria, admitted to our hospital because of renal failure with MHT and thrombocytopenia.
Diagnosis:
This case diagnosed with TMA based on the patient's MHT and thrombocytopenia. The patient final diagnosis was confirmed by the spleen pathological findings, other differential diagnoses were ruled out.
Interventions:
The patient was treated with hemodialysis and intravenous antihypertensive agents, and his condition gradually improved. However, he suddenly complained of abdominal pain and went into hemorrhagic shock, which was due to spontaneous spleen rupture on the third day of hospitalization. The pathological evidence after splenectomy showed splenic TMA.
Outcomes:
Hemodialysis was continued and the blood pressure was under control until his discharge from our hospital.
Conclusion:
Spontaneous splenic rupture could be a rare and critical complication associated with MHT-induced TMA, and it requires careful clinical attention.
Insights
Malignant hypertension-induced thrombotic microangiopathy (TMA) can lead to rare splenic complications. This case highlights spontaneous spleen rupture as a critical, life-threatening event requiring immediate medical attention.
Area of Science:
- Nephrology
- Hematology
- Pathology
Background:
- Thrombotic microangiopathy (TMA) involves endothelial injury and microthrombi formation, often linked to malignant hypertension (MHT).
- MHT is a severe form of hypertension that can affect multiple organs, including the spleen.
Observation:
- A 27-year-old male presented with renal failure, MHT, and thrombocytopenia.
- Diagnosis of TMA was based on MHT and thrombocytopenia, confirmed by splenic pathology.
- The patient developed spontaneous splenic rupture and hemorrhagic shock.
Findings:
- Splenectomy revealed splenic TMA.
- Hemodialysis and antihypertensive agents managed renal failure and blood pressure.
- Spontaneous splenic rupture is a critical complication of MHT-induced TMA.
Implications:
- Highlights a rare, life-threatening complication of MHT-induced TMA.
- Emphasizes the need for careful clinical monitoring in such cases.
- Informs differential diagnosis and management strategies for MHT-related complications.
