Thrombotic Thrombocytopenic Purpura Induced by Trimethoprim-Sulfamethoxazole in a Patient with Rheumatoid Arthritis

Ji Youn Sohn; Kyung Ae Lee; Yun Kyung Hong; Wan-Hee Yoo

doi:10.4078/jkra.2009.16.4.296

Journal List > J Korean Rheum Assoc > v.16(4) > 1003688

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Sohn, Lee, Hong, and Yoo: Thrombotic Thrombocytopenic Purpura Induced by Trimethoprim-Sulfamethoxazole in a Patient with Rheumatoid Arthritis

Original Article

J Korean Rheum Assoc 2009;16(4):296-200.

Published online: 20 January 2009

DOI: https://doi.org/10.4078/jkra.2009.16.4.296

Thrombotic Thrombocytopenic Purpura Induced by Trimethoprim-Sulfamethoxazole in a Patient with Rheumatoid Arthritis

Ji Youn Sohn, Kyung Ae Lee, Yun Kyung Hong, Wan-Hee Yoo

Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and The Research Institute of Clinical Medicine, Jeonju, Korea

Received 15 June 2009 Revised 22 July 2009 Accepted 22 July 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Thromobotic thrombocytopenic purpura (TTP) is a multisystem disorder that's characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia, and neurologic symptoms. TTP is associated with many diseases and several therapeutic drugs. We report here on the first Korean case of a patient with rheumatoid arthritis (RA) and who developed TTP that was associated with trimethoprim-sulfamethoxazole (TMP-SMX) in Korea. She recovered from the TTP following daily sessions of therapeutic plasma exchange (TPE) with fresh plasma replacement and glucocorticoid therapy. Awareness of the possible development of TTP in patient with RA and who is being treated with TMP-SMX is important for making the early diagnosis and administering proper treatment.

Keywords: Thrombotic thrombocytopenic purpura, Rheumatoid arthritis, Trimethoprim-Sulfamethoxazole, Therapeutic plasma exchange, Glucocorticoid

References

1. Murrin RJ, Murray JA. Thrombotic Thrombocytopenic Purpura: aetiology, pathophysiology and treatment. Blood Rev. 2006; 20:51–60.

2. Herrington A, Mahmood A, Berger R. Treatment options in Sulfamethoxazole Trimethoprim-induced thrombocytopenic purpura. South Med J. 1994; 87:948–50.

3. Martin MG, Whitlatch NL, Shah B, Arepally GM. Thrombotic thrombocytopenic purpura induced by Thrimethoprim-Sulfamethoxazole in a Jehovah's Witness. Am J Hematol. 2007; 82:679–81.

4. Kfoury Baz EM, Mahfouz RA, Masri AF. Thrombotic Thrombocytopenic purpura in a patient with rheumatoid arthritis treated by plasmapheresis. Ther Apher. 1999; 3:314–6.

5. Moschowitz E. An acute fevrile pleiochromic anemia with hyaline thrombosis of the terminal arterioles and capillaries: An undescribed disease. Am J Med. 1952; 13:567–9.

6. Li CH, Ho CL. Thrombotic thrombocytopenic purpura as the initial presentation of Pneumocystis jiroveci pneumonia in an immunocompetent patient. Ann Hematol. 2007; 86:223–4.

7. Gopal M, Cohn CD, McEntire MR, Alperin JB. Thrombotic thrombocytopenic purpura and adult onset Still's disease. Am J med Sci. 2009; 337:373–6.

8. Speth PA, Boerbooms AM, Holdrinet RS, Van de Putte LB, Meyer JW. Thrombotic thrombocytopenic purpura associated with D-penicillamine treatment in rheumatoid arthritis. J Rheumatol. 1982; 9:812–3.

9. Trice JM, Pinals RS, Plitman GI. Thrombotic thrombocytopenic purpura during penicillamine therapy in rheumatoid arthritis. Arch Intern Med. 1983; 143:1487–8.

10. Parker JC, Barrett DA, Hill C. Microangiopathic hemolysis and thrombocytopenia related to penicillin drug. Arch Intern Med. 1971; 127:474–7.

11. Elliott MA, Nichols WL Jr, Plumhoff EA, Ansell SM, Dispenzieri A, Gastineau DA, et al. Posttrasplantation thrombotic thrombocytopenic purpura: a single-center experience and a contemporary review. Mayo Clin Proc. 2003; 78:421–30.

12. Smilack JD. Trimethoprim-sulfamethoxazole. Mayo Clin Proc. 1999; 74:730–4.

13. Zakarija A, Bennett C. Drug-induced thrombotic mic-roangiopathy. Semin Thromb Hemost. 2005; 31:681–90.

14. Feiza BA, Samy F, Asma D, Rym B, Insaf M. Urti-carian vasculitis A case report after Sulfamethoxazo-letrimethoprime ingestion. Tunis Med. 2005; 83:714–6.

15. Kremer Hovinga JA, Meyer SC. Current management of thrombotic thrombocytopenic purpura. Curr Opin Hematol. 2008; 15:445–50.

Fig. 1.

Overall, this X-ray shows an irregular ground glass appearance in both lung fields, and this aspect is prominent on the upper lung fields.

Fig. 2.

The HRCT shows consolidations and ground glass opacities in both lung fields, and this it appears with a sparing patterns at the subpleural regions.

Fig. 3.

After 4 days treatment with TMP-SMX, the X-ray shows markedly improved findings.

TOOLS

Similar articles