Background: Thrombotic thrombocytopenic purpura (TTP) is a rare but deadly thrombotic microangiopathy (TMA) that is caused by ADAMTS13 deficiency. The PLASMIC clinical scoring system was developed and validated to determine the pretest probability of severe ADAMTS13 deficiency in cases of suspected TTP. We studied the role of the PLASMIC score in guiding use of the [...]

Case Presentation: A 68-year-old woman with a past medical history of hypertension and relapsing Thrombotic Thrombocytopenic Purpura (TTP) presented with acute kidney injury. She was diagnosed nine years ago with TTP and had three subsequent relapses; the last episode was seven years ago. She had undergone treatment with steroids, rituximab, and plasmapheresis. She was incidentally [...]

Case Presentation: A 77-year-old African-American male with Adult-onset Still’s disease (AOSD) was admitted at the hospital for severe thrombocytopenia. The patient had been diagnosed with AOSD four years before this hospital admission. His AOSD was well-controlled with anakinra, an interleukin-1 receptor antagonist, and low-dose prednisone. On admission, the patient did not have any neurological manifestation. [...]

Case Presentation: A 62-year-old female with diabetes, hyperlipidemia, and hypertension presented after a transient episode of left-sided weakness and dysarthria that resolved by the time of arrival to the emergency department. Vital signs were stable except for a blood pressure of 167/92. Physical exam, including a comprehensive neurologic exam, was negative. Urgent stroke workup was [...]

Case Presentation: A 55-year-old female with a past medical history of seizure disorder and prior opioid use presented to an outside emergency department with a 1-day history of expressive aphasia and headache. Her NIH Stroke Scale was 4. CT head w/o contrast demonstrated a subacute infarct within the left middle cerebral artery (MCA) territory and [...]

Case Presentation: A 37 year-old man presented with altered mental status and a headache after a motor vehicle collision where he was a restrained driver while intoxicated with alcohol. He had a known history of glucose-6-phosphate-dehydrogenase deficiency (G6PD). Exam was notable for superficial abrasions on bilateral upper and lower extremities, diffuse generalized abdominal tenderness to [...]

Case Presentation: A 38-year-old male with self-reported history of asthma presented with generalized weakness and syncope. He endorsed 2-week of bilateral leg pain with numbness, loss of taste, and nausea. Vital signs were remarkable for tachycardia in 110s and hypotension at 101/52. Labs showed hemoglobin 3.3, WBC 3.6, platelet 83, MCV 93.9, reticulocyte 1.1%, total [...]

Case Presentation: A 54-year-old man presented with resolving epigastric pain. Initial labs revealed platelets at 21K/uL. He had no symptoms, signs of bleeding, history of easy bruising or hematologic disease. Further labs showed LDH 690U/L, haptoglobin < 30mg/dL, and bilirubin 2.8mg/dL (indirect 2.2), consistent with intravascular hemolysis. Hgb was 13.4g/dL with MCV 83fL and reticulocyte [...]

Case Presentation: A 53-year-old male with a history of Goodpasture syndrome, systemic lupus, and Wegener’s granulomatosis underwent a deceased donor kidney transplant for end-stage renal disease. Two days post-surgery, the patient developed anemia and thrombocytopenia, elevated lactate dehydrogenase, and increased creatinine, prompting a preemptive diagnosis of TTP. Plasmapheresis was initiated every other day, alternating with [...]

Case Presentation: A 77-year-old female with a history of hypertension and osteoporosis presented to the emergency department with dizziness, fatigue, decreased oral intake, and weakness for a few weeks. She also reported blurry vision and paresthesias in her lower extremities. Physical examination including a neurological examination was normal. Laboratory tests revealed a severe macrocytic anemia [...]