SHM Converge Scientific Abstract ePoster Gallery-Beyond the Pentad: Rare Macrovascular Presentation of Thrombotic Thrombocytopenic Purpura

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This case report describes a rare macrovascular presentation of thrombotic thrombocytopenic purpura (TTP) in a 72-year-old African American woman with prior TTP remission after rituximab. She presented with worsening left-sided hemiparesis and dysarthria, and imaging at an outside hospital showed a right middle cerebral artery (MCA) occlusion, prompting transfer for possible thrombectomy.<br /><br />Although TTP classically affects small vessels, this patient demonstrated a large-vessel stroke with multifocal bilateral cerebral and cerebellar infarcts suggestive of embolic disease. Her laboratory findings, including thrombocytopenia, anemia, and evidence of hemolysis, yielded a PLASMIC score of 7/7, indicating high suspicion for TTP. Initial ADAMTS13 was undetectable, confirming the diagnosis.<br /><br />Because TTP is a hematologic emergency, she was treated immediately with plasma exchange and methylprednisolone. Her neurologic symptoms improved within 24 hours of plasma exchange. By day 5, her platelet count had normalized to 594 and ADAMTS13 had improved to 56%. She was discharged with outpatient follow-up for both TTP and stroke management.<br /><br />The report emphasizes that the classic TTP pentad is specific but not sensitive, and patients may present with only partial features such as anemia, thrombocytopenia, and neurologic deficits. It also highlights potential disparities in rituximab response and relapse-free survival, noting the role of limited diversity and access to clinical trial participation. Overall, the case underscores the importance of prompt recognition of TTP using the PLASMIC score in patients with new anemia, thrombocytopenia, and vascular occlusion.

Asset Subtitle

Deepshika Sudhakar

Meta Tag

Author List Deepshika Sudhakar, Ethan Molitch-Hou, Shannon K. Martin, Susan L. Feldt

Category Clinical Vignettes

Concept Thrombotic Thrombocytopenic Purpura

Concept PLASMIC Score

Concept Total Plasma Exchange

Concept Anemia

Concept Thrombocytopenia

Distinguished Non-Finalist

Presenter Organization University of Chicago, Pritzker School of Medicine

Presenting Author Deepshika Sudhakar

Track Adult

Keywords

thrombotic thrombocytopenic purpura

TTP

macrovascular stroke

middle cerebral artery occlusion

PLASMIC score

ADAMTS13 deficiency

plasma exchange

thrombocytopenia

hemolysis

rituximab remission

Thrombotic Thrombocytopenic Purpura

PLASMIC Score

Total Plasma Exchange

Anemia

Thrombocytopenia