Thrombotic thrombocytopenic purpura associated with Klebsiella pneumonia in the background of alcoholic liver cirrhosis

Abstract

A 75-year-old male patient with alcoholic liver cirrhosis was emergently admitted due to systemic convulsion and Klebsiella pneumonia. He was referred to us due to severe thrombocytopenia (7,000/μl), and we suspected thrombotic thrombocytopenicpurpura (TTP) considering the coexistence of hemolytic findings and neurological symptoms. We promptly performed plasma exchange and administration of corticosteroids, resulting in full recovery of symptoms and laboratory findings in a week. Thediagnosis of TTP was confirmed by severely decreased ADAMTS13 activity (less than 0.5%) and detection of ADAMTS13 inhibitor. In this case, we speculated that TTP was triggered by Klebsiella pneumonia in the background of advanced alcoholicliver cirrhosis. This is the first report describing the complication of Klebsiella pneumonia and TTP. It is important to be awarethat patients complicated with severe liver disease could be vulnerable to TTP.