1 | INTRODUCTION
Thrombotic Thrombocytopenic Purpura (TTP) is a potentially life-threatening condition characterized by severe thrombocytopenia and microangiopathic hemolytic anemia. The primary pathophysiological mechanism is considered to be reduced ADAMTS13 activity, which can be due to inherited gene mutations (hereditary TTP) or the formation of inhibitory autoantibodies (acquired TTP)1(). ADAMTS13 is a von Willebrand factor (VWF)-cleaving protease that prevents the accumulation of ultra-large VWF molecules by cleaving them into smaller fragments. In the absence of ADAMTS13, ultra-large VWF molecules accumulate within vessels, forming platelet-rich microthrombi. Consequently, diminished blood supply to tissues can result in multi-organ damage23(, ). Given the systemic nature of TTP, it can lead to complications in various organs, though some manifestations are exceedingly rare1(). Acute pancreatitis (AP) and myocardial infarction (MI) represent rare complications of TTP. Understanding the broader context of AP and MI helps underscore their clinical relevance in TTP patients. The annual incidence rate of AP ranges between 4.9 and 35 per 100,000 individuals, with mortality rates of 1.5% and 30% in mild and severe cases, respectively4-6(). Hence, early diagnosis and intervention are vital in managing these patients. AP can be attributed to several etiologies, including obstruction of the pancreatic duct due to gallstones (38%), alcohol consumption (36%), and hypertriglyceridemia (up to 4%)7(). In rare instances, pancreatitis can develop secondary to Thrombotic Thrombocytopenic Purpura/Hemolytic Uremic Syndrome (TTP/HUS). Approximately 2% of patients with TTP/HUS develop acute pancreatitis89(, ). This phenomenon is hypothesized to occur due to the necrosis of pancreatic cells, which results from the blockage of pancreatic arterioles by platelet-rich thrombi. However, the etiology remains elusive10(). The occurrence of myocardial infarction (MI) as an initial presentation of thrombotic thrombocytopenic purpura (TTP) is uncommon, largely due to the formation of microthrombi within the cardiac vessels. The precise incidence of myocardial infarction (MI) resulting from TTP remains uncertain; however, studies report the prevalence of TTP-related cardiovascular complications to range between 9.5% and 77%11(). Nevertheless, the occurrence of myocardial infarction as an initial symptom of thrombotic thrombocytopenic purpura is exceedingly uncommon. We present a rare case of a 43-year-old man with acute pancreatitis and myocardial infarction (MI) as the initial presentation of TTP.
| Case history and physical examinations:
A 43-year-old man with no medical history went to the Emergency Department two days before being admitted to the hospital with the main complaint of severe abdominal pain in the epigastric area with radiation to the back, nausea, vomiting, cold sweat, and headaches. The patient had no history of alcohol or drug use. On examination, the patient was conscious and his vital signs were stable. The conjunctiva was pale, and the sclera showed evidence of icterus. Tenderness was observed in the epigastrium. Other examinations had normal results.