Thrombotic microangiopathy with features of thrombotic thrombocytopenic purpura in a patient with Vibrio parahaemolyticus bacteremia: a rare case report.

Abstract

We report the first documented case of thrombotic microangiopathy highly suggestive of thrombotic thrombocytopenic purpura (TTP) associated with Vibrio parahaemolyticus bacteremia in an immunocompetent adult. A 62-year-old man developed acute gastroenteritis following seafood ingestion and rapidly progressed to bacteremia with severe thrombocytopenia, microangiopathic hemolytic anemia, acute kidney injury, and neurological impairment. Laboratory evaluation revealed  ~ 3% schistocytes, markedly elevated lactate dehydrogenase, indirect hyperbilirubinemia, preserved coagulation parameters, and a negative direct Coombs test. The PLASMIC score indicated a high probability of severe ADAMTS13 deficiency. Given the classical clinical presentation, urgent plasma exchange (PLEX) was initiated, resulting in rapid and sustained hematologic and clinical recovery. Blood cultures confirmed Vibrio parahaemolyticus, and targeted ciprofloxacin therapy was administered. Although ADAMTS13 activity testing was unavailable, the constellation of findings and dramatic response to PLEX strongly support a diagnosis of TTP triggered by Vibrio bacteremia. This case highlights the importance of early recognition of TTP-like TMA, even when triggered by uncommon pathogens, and demonstrates the lifesaving role of prompt PLEX therapy.