SHM Converge Scientific Abstract ePoster Gallery-Recurrent Acquired Thrombotic Thrombocytopenic Purpura in the Setting of Ruptured Silicone Breast Implants

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This case report describes a 32-year-old woman with recurrent acquired thrombotic thrombocytopenic purpura (TTP) suspected to be triggered by ruptured silicone breast implants. She had a prior episode of TTP after breast implant placement 11 years earlier, along with a history of systemic lupus erythematosus and asthma. Five months postpartum, she developed back pain, fatigue, confusion, anemia, and easy bruising, with intermittent right breast tenderness and pruritus. Her pregnancy had been complicated by right breast swelling requiring repeated aspiration; cytology was negative for ALCL.<br /><br />Laboratory findings were consistent with TTP: thrombocytopenia, hemolytic anemia, schistocytes on peripheral smear, elevated D-dimer, elevated creatinine, and an ADAMTS13 activity of 1% with negative inhibitor. Her PLASMIC score was 7, indicating high risk for severe ADAMTS13 deficiency. CTA of the chest showed bilateral implant irregularity and adjacent fluid collections, suggesting bilateral silicone breast implant rupture.<br /><br />She was treated urgently with fresh frozen plasma, plasma exchange (PLEX) for five sessions, and prednisone 1 mg/kg, followed by rituximab. Platelets rapidly improved from 17,000 to over 300,000. Once her platelet count recovered, she underwent surgical removal of the breast implants and continued outpatient rituximab.<br /><br />The report emphasizes that acquired TTP is a life-threatening hematologic emergency requiring rapid recognition and treatment. It also highlights the importance of obtaining a detailed cosmetic and surgical history, since silicone breast implants may act as a trigger for immune-mediated disease and, in rare cases, TTP relapse. This is only the second reported case of breast implant-associated TTP.

Asset Subtitle

Wajiha Kazmi

Meta Tag

Author List Jiwon Hong, Saurabh Kumar, Wajiha Kazmi

Category Clinical Vignettes

Concept Thrombotic Thrombocytopenic Purpura

Concept Immune-mediated Thrombotic Thrombocytopenic Purpura

Concept ADAMTS13

Concept Total Plasma Exchange

Concept PLASMIC Score

Distinguished Non-Finalist

Presenter Organization Zucker School of Medicine at Hofstra/Northwell

Presenting Author Wajiha Kazmi

Track Adult

Keywords

thrombotic thrombocytopenic purpura

acquired TTP

silicone breast implants

implant rupture

ADAMTS13 deficiency

plasma exchange

rituximab

thrombocytopenia

hemolytic anemia

autoimmune disease

Thrombotic Thrombocytopenic Purpura

Immune-mediated Thrombotic Thrombocytopenic Purpura

ADAMTS13

Total Plasma Exchange

PLASMIC Score