CANCER PRESENTING AS THROMBOTIC THROMBOCT YOPENIC PURPURA - 2 CASE-REPORTS

Thrombotic thrombocytopenic purpura (TTP) causes severe haemolytic ana emia, thrombopenia, fever and neurological and renal involvement. Curr ently five large aetiologic groups have been identified: viral or bact erial infection, drugs, conjunctive tissue diseases, pregnancy and sol id tumours. We observed two cases resulting from an adenocarcinoma. In the first case, a 71-year-old man with chronic silicosis, the present ing signs were asthenia, fever, epistaxis with diffus purpura and spon taneous haematomas of the lower limbs. Diagnosis of TTP was based on r outine laboratory tests and the patient responded well to fresh frozen plasma. On the 5th day of treatment, haemoglobin level dropped sharpl y and melana occurred. Upper digestive tract endoscopy revealed a tumo ural Formation of the antrum-fundic junction and histology examination of the biopsy confirmed the diagnosis of adenocarcinoma. Ten months a fter gastrectomy the patient was in excellent health with no relapse o f the TTP. In the second case, the presenting signs included spontaneo us haematomas, rectorrhagia and low grade fever. Microscopic haematuri a and renal failure were observed in addition to the biological syndro me of TTP. The patient responded poorly to fresh frozen plasma and pac ked cell transfusions. Plasma exchange was equally unsuccessful. The d isease continued a fulminant course and the diagnosis of adenocarcinom a located in a pulmonary lymph nodes was made at autopsy. These rare c ases of TTP caused by cancer emphasize the importance of a thorough ae tiological research. Plasma exchange has been shown to be effective bu t mortality at 1 year approximately 85% in cancer related cases. Early diagnosis and specific anti-cancer therapy might improve prognosis. W e report our personal experience with 16 other similar cases.