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Occult systemic malignancy masquerading as thrombotic thrombocytopenic purpura–hemolytic uremic syndrome
The University of Oklahoma Health Sciences Center, Oklahoma City, OK
The occurrence of microangiopathic hemolytic anemia and thrombocytopenia in patients with disseminated malignant disorders has been well documented. However, when systemic malignancy is not clinically apparent, these features may be misdiagnosed as thrombotic thrombocytopenic purpura–hemolytic uremic syndrome (TTP-HUS), and patients may be treated with plasma exchange, a procedure with substantial risk. Among the 329 patients in the Oklahoma TTP-HUS Registry, 1989–2005, 12 patients who were treated with plasma exchange for presumed TTP-HUS were later found to have a systemic malignancy. Details about one such patient, a 52-year-old woman who had a history of breast cancer, are presented. Although some of her clinical features were atypical for TTP-HUS, and the possibility of recurrent breast cancer was carefully considered, no evidence of cancer was found and plasma exchange treatment for TTP-HUS was initiated. Disseminated breast cancer was not revealed until a microscopic examination of tissue sections was made at autopsy. In retrospect, a bone marrow biopsy might have documented the presence of metastatic cancer in this patient. Hematologists/oncologists must be aware that patients with clinically diagnosed TTP-HUS may have an occult systemic malignant disorder.
| Commun Oncol 2005;2:339–343 | full text |  127 kb |