Thrombotic microangiopathy with pulmonary hemorrhage: A rare case report

Area of Science:

• Nephrology
• Hematology
• Pathology

Background:

• Thrombotic microangiopathy (TMA) encompasses diverse etiologies leading to endothelial damage, microvascular thrombosis, mechanical hemolysis, thrombocytopenia, and ischemic organ damage.
• Untreated TMA carries a high mortality rate, underscoring the importance of identifying its underlying cause for timely intervention.

Observation:

• A 47-year-old female with hypertension presented with accelerated hypertension and a TMA picture, manifesting as rapidly progressive renal failure.
• Renal biopsy revealed patchy cortical necrosis with hypertensive changes, indicating severe vascular compromise.

Findings:

• The patient required hemodialysis and remained dialysis-dependent, ultimately succumbing to pulmonary edema and alveolar hemorrhage.
• The TMA in this case was potentially attributable to malignant hypertension or atypical hemolytic-uremic syndrome, highlighting diagnostic challenges.

Implications:

• Thrombotic microangiopathy is a medical emergency requiring a high index of suspicion, particularly with multisystem involvement, hemolysis, and thrombocytopenia.
• Accurate diagnosis of TMA etiology is critical for initiating appropriate and potentially life-saving treatments.