Thrombotic Thrombocytopenic Purpura in a Patient with Brucella Infection

Thrombotic thrombocytopenic purpura (TTP) is characterized by disseminated thrombotic occlusions in the microcirculation and a syndrome of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, fever, renal and neurologic abnormalities. Several factors such as viral and bacterial pathogens, pancreatitis, drugs, collagen-vascular diseases, cancers, and pregnancy have been reported to cause TTP, Brucellosis is an exceptional cause of this disorder. We present a case of a 33 year old male who was found to have Brucella antigen (IgG) positivity who responded well to antibiotic therapy directed to Brucella infection. He subsequently reported back with B/L diminution of vision, fever and was found to have severe thrombocytopenia. Ophthalmology opinion revealed retinal hemorrhages. In view of severe thrombocytopenia with a normal coagulogram, raised LDH, renal azotemia and peripheral blood smear showing fragmented RBCs he was diagnosed to have Thrombotic Thrombocytopenic Purpura (TTP) secondary to Brucellosis. He was immediately treated with Plasma exchange; however, he relapsed after initial cycles. He underwent further plasma exchanges with unsatisfactory response, thus was eventually started on Rituximab to which he responded well.