Sudden Cardiac Death in Thrombotic Thrombocytopenic Purpura -- A Case Report and Review of the Literature

A 54-year-old man with thrombotic thrombocytopenic purpura ( TTP ) who developed sudden cardiac death is described. The clinical presentations of this case were typical including thrombocytopenic purpura, fever, neurologic deficit and renal abnormalities. On admission, plasma exchange was started soon after the diagnosis of TTP was made. Unfortunately, his condition deteriorated and went into a rapid outcome of death. The causes of mortality were discussed. We found that the reasonable cause of sudden death may be cardiac involvement of TTP. On the other hand, appearance of torsades de pointes during the therapy with plasma exchange could be considered as a contributing factor of his mortality. Understanding a high risk of sudden cardiac death in TTP and the possibility of lethal arrhythmia present in plasma exchange underlines the importance of early diagnosis, immediate treatment and prophylactic therapy in plasma exchange. ( J Intern Med Taiwan 2002;13:154-159 )