Ioana Amzuta

The spectrum of thrombotic thrombocytopenic purpura: a clinicopathologic demonstration of tacrolimus-induced thrombotic thrombocytopenic purpura in a lung transplant patient.

Immunosuppressive drugs used post-transplantation are among the most common causes of thrombotic thrombocytopenic purpura (TTP). Diagnosis is often confounded not only by its myriad presentations, but also because these manifestations may be explained by the comorbidities or complications of transplantation. A 61-year-old female who had a single lung transplant for severe chronic obstructive pulmonary disease maintained on corticosteroids, tacrolimus and mycophenolate mofetil, was admitted for fever, headache with confusion and lethargy. She was mildly anemic and thrombocytopenic. Peripheral smear showed rare fragmented red cells. Muddy brown casts were present on urinalysis. She was diagnosed with TTP. Tacrolimus was discontinued and the mental status of the patient, anemia and thrombocytopenia improved significantly.

A 33-year-old man with chest pain, left upper lobe mass, pulmonary nodules, and bilateral bullae.

A 33-year-old man was referred to our institution for evaluation of multiple pulmonary nodules. The patient had been in his usual state of health until a week prior to admission, when he presented to an outside hospital with complaints of right-sided chest pain. An initial chest radiograph revealed multiple pulmonary nodules, and a CT scan of the chest confi rmed the nodules. The CT scan of the chest also demonstrated a left upper lobe mass. The patient was referred to our institution. A review of systems revealed only the presence of right-sided chest pain for 1 week. The patient had no significant medical history. He had a 15-pack-year smoking history. He denied any travel history or contact with sick people or pets. His family history was significant for lung cancer and breast cancer in his paternal grandmother.