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Early Relapse of Thrombotic Thrombocytopenic Purpura duringTherapeutic Plasma Exchange Associated with Acinetobacter anitratus Bacteremia

Abstract:  Thrombotic thrombocytopenic purpura (TTP)/Hemolytic–uremicsyndrome (HUS) is a syndrome characterized by thrombocytopenia,microangiopathic hemolytic anemia, fever, renal failure and neurologic manifestation.Almost all cases are idiopathic. However, secondary TTP/HUSassociated with viral, bacterial and mycobacterial infections, drugs,connective tissue disease, solid tumors, bone marrow transplantationand pregnancy have been described. Early relapse associated withinfection is a rare occurrence. The patient we report had a classic caseof postdiarrheal TTP/HUS that responded to plasmapheresisbut relapsed during treatment as reflected by the increased schistocytosis,decreased hematocrit, increased lactate dehydrogenase, and decreased platelet counts. This relapse may be attributed to Acinetobacteranitratus bacteremia, secondary to central line infection. Administrationof antimicrobial treatment resulted initially in a mild improvement.However, this was followed by a fatal relapse. The importance ofmonitoring the possible bacterial colonization of an indwellingcatheter is thus emphasized.