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Dengue Virus Infection Triggering Thrombotic Thrombocytopenic Purpura in Pregnancy

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  • Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

We report a case of thrombotic thrombocytopenic purpura (TTP) that immediately followed symptomatic dengue virus infection in a pregnant lady. The patient developed dengue fever at 16 weeks of gestation, resulting in spontaneous abortion. Subsequently, fever reappeared with persistent thrombocytopenia and jaundice. Investigations revealed microangiopathic hemolysis; there was no evidence of disseminated intravascular coagulation. The TTP episode resolved after six cycles of therapeutic plasma exchange with fresh-frozen plasma. An ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 motif 13 repeats) activity assay, done during convalescence, showed normal activity. The patient had an uneventful second pregnancy and has remained free of TTP recurrence for more than 2 years now. We review the pathophysiological basis of TTP in dengue infection, and suggest that jaundice with disproportionate elevation of serum aspartate aminotransferase level in a patient with dengue should arouse the suspicion of TTP.

Author Notes

* Address correspondence to Tamilarasu Kadhiravan, Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India. E-mail: kadhir@jipmer.edu.in

Authors' addresses: Surendran Deepanjali, Raghuramulu R. Naik, Sharada Mailankody, Sivamani Kalaimani, and Tamilarasu Kadhiravan, Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, E-mails: deepanjali.s@jipmer.edu.in, raghu2010jipmer@gmail.com, sharadajayaram27@gmail.com, kalaimani.sivamani@gmail.com, and kadhir@jipmer.edu.in.

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