Staphylococcus aureus bacteremia as a cause of early relapse of thromboticthrombocytopenic purpura

BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is a multisystem dise ase characterized by the sudden onset of hemolytic anemia, thrombocytopenia , fever, renal failure, and neurologic dysfunction, occurring in Various co mbinations. The most effective treatment of TTP is plasma exchange and the administration of corticosteroids, which reduces mortality from the 90 perc ent seen in untreated patients to 10 percent. CASE REPORTS: Two patients responded favorably to plasma exchange and corti costeroid therapy, but their TTP relapsed during treatment. In both cases, the early relapse of TTP was associated with Staphylococcus aureus bacterem ia secondary to central line infection. Treatment of the infection and inte nsification of the plasma exchange regimen resulted in a sustained remissio n. CONCLUSION: Infection should be actively sought and treated in TTP patients who are refractory to treatment or in whom an exacerbation of the disease occurs while they are undergoing plasma exchange.