Case report: post-delivery thrombotic thrombocytopenic purpura complicated by malignant catatonia

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia (MAHA), renal dysfunction, fever, and neurological symptoms. Postpartum TTP, although uncommon, arises due to hormonal, immunological, and coagulation changes with pregnancy. We present a 21-year-old postpartum female developed TTP shortly after delivery, presenting with bluish skin patches, jaundice, leg swelling, and oliguria. The diagnosis of neurological TTP was presumed based on clinical presentation, as ADAMTS13 testing was unavailable. Treatment included plasma exchange, corticosteroids, and hemodialysis. Despite therapy, she developed severe neurological symptoms, including seizures, mutism, and autonomic instability, ultimately diagnosed as malignant catatonia, a rare neuropsychiatric complication of TTP. administration of intravenous benzodiazepines and rituximab led to significant clinical improvement and recovery. This case underscores complexity of postpartum TTP with rare complications like malignant catatonia, and highlights critical importance of early recognition, management, and maintaining a high index suspicion for atypical postpartum presentations.