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Marked Improvement in Refractory TTP Directly after H. pylori Eradication Therapy.

Gringauz I, Carmel-Neiderman NN, Mangel T, Portnoy O, Segal G, Goren I - Case Rep Hematol (2016)

Bottom Line: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder involving thrombotic microangiopathy and is characterized by increased platelet aggregation throughout the body.The TTP was highly resistant to medical therapy; however the patient underwent complete resolution of her TTP following H. pylori eradication.We conclude that acquired TTP may be triggered by H. pylori infection and that treating the underlying infection may play a role in improving TTP's outcome in some patients, especially when disease is refractory to medical therapy.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Ward T, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.

ABSTRACT
Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder involving thrombotic microangiopathy and is characterized by increased platelet aggregation throughout the body. Acquired TTP can be triggered by a variety of conditions including infections. We hereby describe a case report of an 81-year-old female presenting to the internal medicine department with TTP and active chronic gastritis, positive for Helicobacter pylori (H. pylori) on biopsy. The TTP was highly resistant to medical therapy; however the patient underwent complete resolution of her TTP following H. pylori eradication. We conclude that acquired TTP may be triggered by H. pylori infection and that treating the underlying infection may play a role in improving TTP's outcome in some patients, especially when disease is refractory to medical therapy.

No MeSH data available.


Related in: MedlinePlus

The graph illustrates the patient's platelet levels (per 1000) with different types of treatments. From the data, it is apparent that after the patient was given antibiotics the platelet levels were both stabilized and remained within normal limits.
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fig2: The graph illustrates the patient's platelet levels (per 1000) with different types of treatments. From the data, it is apparent that after the patient was given antibiotics the platelet levels were both stabilized and remained within normal limits.

Mentions: At this stage rituximab treatment was initiated with only mild elevation in platelets count but no clinical significant improvement. During hospitalization the patient developed a deep vein thrombosis and treatment with low molecular weight heparin (LMWH) was initiated. Further investigation with gastroduodenoscopy demonstrated normal esophagus with a few erosions in the antrum of the stomach and was consistent with gastritis. Gastric biopsy found moderate active chronic gastritis and was positive for H. pylori and negative for dysplasia. Colonoscopy showed no significant findings. The patient was treated for 10 days with a triple-therapy regime consisting of omeprazole, amoxicillin, and clarithromycin. Soon after completion of antibiotics therapy TTP regressed and platelets count returned to normal (Figure 2). Similarly, both reticulocytes count and LDH levels were decreased after triple-therapy completion 2.5% versus 0.7% and 302 IU/L versus 182 IU/L for pretreatment versus posttreatment analysis accordingly. In addition, haptoglobin levels rose after eradication therapy from 31.2 mg/dL to 99.3 mg/dL. In the last follow-up one year later, the patient was well, without any complaints. Blood count and platelets remained within normal limits and the patient was free of symptoms.


Marked Improvement in Refractory TTP Directly after H. pylori Eradication Therapy.

Gringauz I, Carmel-Neiderman NN, Mangel T, Portnoy O, Segal G, Goren I - Case Rep Hematol (2016)

The graph illustrates the patient's platelet levels (per 1000) with different types of treatments. From the data, it is apparent that after the patient was given antibiotics the platelet levels were both stabilized and remained within normal limits.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835621&req=5

fig2: The graph illustrates the patient's platelet levels (per 1000) with different types of treatments. From the data, it is apparent that after the patient was given antibiotics the platelet levels were both stabilized and remained within normal limits.
Mentions: At this stage rituximab treatment was initiated with only mild elevation in platelets count but no clinical significant improvement. During hospitalization the patient developed a deep vein thrombosis and treatment with low molecular weight heparin (LMWH) was initiated. Further investigation with gastroduodenoscopy demonstrated normal esophagus with a few erosions in the antrum of the stomach and was consistent with gastritis. Gastric biopsy found moderate active chronic gastritis and was positive for H. pylori and negative for dysplasia. Colonoscopy showed no significant findings. The patient was treated for 10 days with a triple-therapy regime consisting of omeprazole, amoxicillin, and clarithromycin. Soon after completion of antibiotics therapy TTP regressed and platelets count returned to normal (Figure 2). Similarly, both reticulocytes count and LDH levels were decreased after triple-therapy completion 2.5% versus 0.7% and 302 IU/L versus 182 IU/L for pretreatment versus posttreatment analysis accordingly. In addition, haptoglobin levels rose after eradication therapy from 31.2 mg/dL to 99.3 mg/dL. In the last follow-up one year later, the patient was well, without any complaints. Blood count and platelets remained within normal limits and the patient was free of symptoms.

Bottom Line: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder involving thrombotic microangiopathy and is characterized by increased platelet aggregation throughout the body.The TTP was highly resistant to medical therapy; however the patient underwent complete resolution of her TTP following H. pylori eradication.We conclude that acquired TTP may be triggered by H. pylori infection and that treating the underlying infection may play a role in improving TTP's outcome in some patients, especially when disease is refractory to medical therapy.

View Article: PubMed Central - PubMed

Affiliation: Internal Medicine Ward T, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.

ABSTRACT
Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder involving thrombotic microangiopathy and is characterized by increased platelet aggregation throughout the body. Acquired TTP can be triggered by a variety of conditions including infections. We hereby describe a case report of an 81-year-old female presenting to the internal medicine department with TTP and active chronic gastritis, positive for Helicobacter pylori (H. pylori) on biopsy. The TTP was highly resistant to medical therapy; however the patient underwent complete resolution of her TTP following H. pylori eradication. We conclude that acquired TTP may be triggered by H. pylori infection and that treating the underlying infection may play a role in improving TTP's outcome in some patients, especially when disease is refractory to medical therapy.

No MeSH data available.


Related in: MedlinePlus