Ibuprofen-induced thrombotic thrombocytopenic purpura

In this study, we describe a case of ibuprofen-induced thrombotic thrombocytopenic purpura (TTP). This patient is a 37-year-old African American man who was found unresponsive on the floor. It was later found that he ingested 30 ibuprofen pills (400 mg) with a total dose of 12 g in an attempt to commit suicide. The patient was noted to have a pale conjunctivae, scleral icterus, vitiligo, and left arm weakness. Upon Foley placement, hematuria with no clotswas collected. Complete blood count revealed hemoglobin level of 6.3 mg/dL, hematocrit of 19.1%, and platelet count of 29 000/mu L. The patient was treated initially in the emergency department for severe anemia and received 1 unit of packed red blood cells. Later on, a diagnosis of TTP was more evident based on clinical findings and laboratory results; schistocytes were appreciated on the peripheral blood smear along with hemolytic anemia, severe thrombocytopenia, acute kidney injury, and an altered mental status. A disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13, level was noted to be less than 3%, a low haptoglobin of less than 15 mg/dL, and lactate dehydrogenase (LDH) of 2308 U/L confirming a diagnosis of TTP. Thrombotic thrombocytopenic purpura complications developed in this patient due to his high thrombotic state. He had a non-ST-elevation myocardial infarction as well as a right parietal infarct. The patient was treated in the hospital where he received plasma exchange for 3 weeks, along with prednisone and rituximab. This case illustrates an unusual cause of TTP, where ibuprofen induces antibodies against a disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13.