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.