SHM Converge Scientific Abstract ePoster Gallery-A Stroke of Misfortune: Thrombotic Thrombocytopenic Purpura-Associated Cerebral Infarct Initially Diagnosed as High-Grade Central Nervous System Tumor

A Stroke of Misfortune: Thrombotic Thrombocytopenic Purpura-Associated Cerebral Infarct Initially Diagnosed as High-Grade Central Nervous System Tumor

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This case describes a 53-year-old previously healthy woman who initially presented with acute expressive aphasia and mild thrombocytopenia. Brain CT showed multiple infarcts, while MRI revealed a 1.7 cm mass-like enhancing left frontal lesion concerning for malignancy. Extensive malignancy workup was negative, and she was discharged with improving symptoms and planned follow-up imaging.<br /><br />Three weeks later, she returned with worsened aphasia and fever. Repeat labs now showed anemia, severe thrombocytopenia, elevated LDH/creatinine, and MRI demonstrated evolution of the same lesion into a subacute infarct rather than neoplasm. Given the combination of neurologic symptoms and thrombocytopenia, clinicians suspected immune-mediated thrombotic thrombocytopenic purpura (iTTP). Treatment with therapeutic plasma exchange and corticosteroids was started, and the diagnosis was confirmed by severe ADAMTS13 deficiency (2%). Rituximab was added, but caplacizumab was withheld because of concern for intracranial bleeding. She improved and was discharged stable on hospital day 7.<br /><br />The report highlights several learning points: TTP should remain on the differential diagnosis in patients with neurologic deficits and thrombocytopenia, even when classic hemolysis is not obvious; neuroimaging in TTP can be misleading and may mimic malignancy or other pathologies; caplacizumab can improve outcomes but requires individualized bleeding-risk assessment; and reduced ADAMTS13 activity may increase stroke risk even outside of overt TTP.<br /><br />Overall, the case emphasizes that cerebral infarcts may be an early or atypical manifestation of TTP, and delayed recognition can complicate both diagnosis and treatment.

Asset Subtitle

Omair Ahmed

Meta Tag

Author List Omair Ahmed, Ross Comisford, Spero Cataland

Category Clinical Vignettes

Concept Immune-mediated Thrombotic Thrombocytopenic Purpura

Concept ADAMTS13 Deficiency

Concept Total Plasma Exchange

Concept Thrombotic Microangiopathy

Concept Neurologic Symptoms

Distinguished Non-Finalist

Presenter Organization The Ohio State University Wexner Medicial Center

Presenting Author Omair Ahmed

Track Adult

Keywords

thrombotic thrombocytopenic purpura

ADAMTS13 deficiency

cerebral infarct

aphasia

thrombocytopenia

plasma exchange

corticosteroids

rituximab

caplacizumab

stroke risk

Immune-mediated Thrombotic Thrombocytopenic Purpura

ADAMTS13 Deficiency

Total Plasma Exchange

Thrombotic Microangiopathy

Neurologic Symptoms