From Common Symptom to Critical Diagnosis: Vertigo as a Clue to Thrombotic Thrombocytopenic Purpura

Thrombotic thrombocytopenic purpura is a hematologic disease with a high mortality rate that affects multiple organ systems. It is caused by a deficiency of a metalloprotease known as the ADAMTS-13 enzyme. Patients can present with fever, hemolytic anemia, thrombocytopenia, kidney injury, and neurological symptoms. Here we present a case of a female with TTP who was initially diagnosed with benign paroxysmal positional vertigo (BPPV). Her initial symptoms were vertigo, blurry vision, and gait imbalance, which were accompanied by elevated total bilirubin, acute kidney injury, thrombocytopenia, and normal hemoglobin. When the patient followed up in her primary care clinic, she was found to have worsening renal function, hemolytic anemia, and severe thrombocytopenia. She was subsequently diagnosed with TTP and referred to the emergency department (ED) where she received emergent treatment with therapeutic plasma exchange (TPE) and later rituximab. This case stresses the importance of considering TTP in patients presenting with symptoms and laboratory values suggestive of the disease, even when anemia is not present.