Thrombotic Thrombocytopenic Purpura Without Neurological Involvement: A Case Report and Review of the Diagnostic and Treatment Strategies

This case report describes the presentation of thrombotic thrombocytopenic purpura (TTP) without neurological involvement in a 48-year-old woman. TTP is a relatively rare, life-threatening condition that comprises thrombotic microangiopathy (TMA) and enzymatic dysfunction of ADAMTS13 (a disintegrin-like metalloproteinase with thrombospondin motif type 1, member 13, which regulates platelet aggregation). Another similar condition that presents with TMA in adults is atypical hemolytic uremic syndrome. It is challenging to differentiate between the two conditions clinically, especially in the absence of neurological symptoms. However, plasma exchange is the initial lifesaving treatment for both in acute situations. Our patient had a history of bruising, which was evident in clinical examination, without any other positive findings. However, ADAMTS13 activity was 0%, and the platelet count was 4 × 10⁹/L on arrival. Timely investigation and treatment not only saved her life but also reduced end-organ damage. This report provides an overview of the acute presentation of TTP, positive clinical findings, investigations, diagnosis, treatment, and post-treatment outcomes.