Massive myocardial necrosis in thrombotic thrombocytopenic purpura - A case report and review of the literature

Thrombotic thrombocytopenic purpura (TTP) is an uncommon syndrome resulting from diffuse occlusion of small arterioles and capillaries by hyaline micr othrombi. It is characterized by fever, thrombocytopenic purpura, microangi opathic hemolytic anemia, and neurologic and renal dysfunction. While cardi ac pathology in TTP is commonly seen at autopsy, clinical cardiac dysfuncti on is rare and typically results from conduction system involvement. While 3% to 8% of patients with TTP report chest pain on admission, reports of fa tal ventricular pump failure are extremely rare. We now report a case of TT P resulting in death from widespread myocardial necrosis. This patient pres ented with elevated cardiac enzymes and electrocardiographic disturbances t hat mimicked viral myocarditis, bs well as a profound thrombocytopenia. Suc h a case may represent the extreme of a distribution of cardiac involvement in TTP or the consequence of an unidentified autoimmune process capable of precipitating severe myocardial TTP.