Fulminant myocarditis in immune-mediated thrombotic thrombocytopenic purpura: A case report

Thrombotic thrombocytopenic purpura is a life-threatening thrombotic microangiopathy characterized by systemic microvascular thrombosis. Cardiovascular complications, including myocardial ischemia and necrosis, are a leading cause of acute mortality.

A 54-year-old man was diagnosed with immune-mediated thrombotic thrombocytopenic purpura. On Day 2, he developed sudden cardiac arrest, requiring venoarterial extracorporeal membrane oxygenation for circulatory support. Echocardiography revealed diffuse severe hypokinesis, ventricular hypertrophy, and pericardial effusion. Myocardial biopsy performed on Day 3 showed no findings of microthrombi or necrosis. These findings suggested fulminant myocarditis rather than myocardial ischemia. The patient was successfully treated with multidisciplinary treatment including plasma exchange, achieving full recovery by Day 44.

This case highlights fulminant myocarditis as a complication of immune-mediated thrombotic thrombocytopenic purpura. As myocarditis is potentially reversible, providing appropriate supportive therapy may contribute to an improved prognosis.