Immune thrombotic thrombocytopenic purpura complicated with Evans syndrome: a case report and literature review

The co-occurrence of immune-mediated thrombotic thrombocytopenic purpura (iTTP) and Evans syndrome (ES) is clinically rare. This article reports the rare case of a 73-year-old male patient with simultaneous iTTP and ES. He was admitted due to "dry cough for 1 month, fever for half a month, and impaired consciousness for 3 days." Initial symptomatic treatments included anticoagulation and correction of heart failure, but his hemoglobin and platelet counts declined progressively. He was later diagnosed with iTTP following consultation with the hematology department and laboratory tests. His platelet count and lactate dehydrogenase levels improved after plasma exchange plus corticosteroid therapy for 3 days; however, the family ultimately opted to discontinue treatment due to progressive multiple organ dysfunction. This report discusses the clinical and pathological mechanisms and therapeutic challenges associated with coexisting iTTP and ES, highlighting the importance of multidisciplinary collaboration and individualized diagnosis and treatment.