A CASE OF DERMATOMYOSITIS COMPLICATED BY THROMBOTIC THROMBOCYTOPENIC PURPURA

A 60-year-old man with dermatomyositis was admitted to our hospital be cause of dyspnea and hypertension. He had high fever and convulsive se izures after admission. Laboratory examinations showed hemolytic anemi a, thrombocytopenia, and renal failure. A clinical diagnosis of thromb otic thrombocytopenic purpura (TTP) was made. He failed to respond to plasma exchange therapy, pulse therapy with methylprednisolone, high-d ose gamma-globulin therapy, and antiplatelet therapies with ticlopidin e, dipyridamole and a prostacyclin analog of beraprost sodium. He died on his 17th day in hospital. Autopsy examination revealed widespread microthrombi in his kidneys, lungs, spleen, and intestine. Only seven cases of dermatomyositis or polymyositis complicated by TTP have been cited in the literature. TTP was fatal in 6 of these 7 cases. Early di agnosis and prompt treatment may improve the outcome of TTP patients w ith dermatomyositis. Dermatologists should keep in mind that TTP occas ionally arises as a serious complication of dermatomyositis.