Sepsis Mimicking TTP-Case Report and Review of Literature

Abstract

Here we report a case of Sepsis mimicking as thrombotic thrombocytopenic purpura in a cancer patient with Urothelioma. A 61-year-old man with High grade Urothelial Carcinoma of left renal pelvis (Multifocal disease) Stage-4 presented with Fever on and off since 1 week and shortness of breath at rest since 2 days and hematuria since 1 day.Later in the course, he developed thrombocytopenia followed by MAHA (Micro Angiopathic haemolytic Anaemia), and other lab abnormalities .Thrombotic thrombocytopenic purpura (TTP) was suspected, and total plasma exchange was considered. Since serum procalcitonin,Total leucocyte count was very high and also had elevated prothrombin time, ADAMTS13(a disintegrin and metalloproteinase with thrombospondin type 1 motifs, member 13) was sent for confirmation showed that ADAMTS13 activity of more than 10% for which plasmapheresis was delayed , later patient was treated for sepsis , but patient did not respond and succumbed . This case shows that Sepsis can mimic TTP making diagnosis and treatment extremely difficult. In this type of clinical dilemma to do total plasma exchange (TPE) which is the main modality of treatment for TTP ADAMTS13 activity helps us to prioritise treatment.