HIV-related thrombotic thrombocytopenic purpura (TTP) as first clinical manifestation of infection.

A case of thrombotic thrombocytopenic purpura (TTP) in a 40-year-old bisexual man unaware of being HIV positive is reported. The hematologic syndrome represented the first clinical manifestation of this viral infection. The clinical picture, characterized by severe hemolytic microangiopathic anemia, thrombocytopenia, fluctuating neurologic abnormalities and fever, quickly improved after plasma exchange and corticosteroid therapy. Two blood tests showed severe depletion of the CD4+ lymphocyte count and HIV antigenemia was positive. This case represents a clinical epiphenomenon of HIV infection in an advanced phase. According to recent CDC criteria the patient should be considered in AIDS. Antiretroviral treatment was started and after nine months of follow-up there has been no relapse.