Thrombotic Thrombocytopenic Purpura Presenting as a Complex Migraine: A Case Report

Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia, fever, neurologic symptoms, and renal dysfunction. Neurologic manifestations can range from mild headaches to severe sequelae such as seizures, stroke, and coma. TTP may present atypically, including with symptoms such as complex migraines, which can complicate diagnosis and delay treatment. Early recognition and prompt treatment are essential, as untreated TTP carries a high mortality rate. This case report highlights the importance of considering TTP in the differential diagnosis of patients presenting with a first-time complex migraine, as it can occasionally be the initial manifestation of this rare and serious condition. It also underscores the necessity of performing a complete blood count (CBC) in patients with new neurological symptoms, as complex pathologies like TTP can present with overlapping features. We present the case of a 19-year-old male whose initial complaint of a complex migraine led to the diagnosis and successful treatment of TTP with plasmapheresis, corticosteroids, and rituximab.