ANAMNESIS AND CLINICAL FINDINGS: A 75-year-old woman with a history of recurrent 
ischemic cerebral events was admitted with acute unspecific neurological 
symptoms and fever.
EXAMINATION: Intracerebral hemorrhage due to hypertension and antithrombotic 
therapy with ticlopidine was ruled out with cranial computed tomography. 
Laboratory findings on admission included thrombocytopenia (12/nl), renal 
insufficiency (serum creatinine 1.6 mg/dl) and LDH elevation (1,218 U/l). The 
hemoglobin on admission was normal.
THERAPY AND CLINICAL COURSE: In the presence of rapidly declining hemoglobin 
values and fragmentation of red cells thrombotic-thrombocytopenic purpura (TTP) 
was diagnosed and the patient received fresh frozen plasma. Shortly after the 
plasma infusion the patient's condition deteriorated rapidly showing clinical 
signs of an allergic shock. In the sequel of 24 to 48 hours the patient 
developed renal failure, severe anemia and the thrombocyte count fell to 5/nl. 
The patient was mechanically ventilated during the next 48 hours and needed 
intravenous catecholamines. Even after restoration of spontaneous respiration 
and cessation of pharmacological sedation the patient remained comatose. Cranial 
computed tomography on the fourth day after admission showed multiple infarction 
syndrome. The patient died on the ninth day after admission in status 
epilepticus which could not be stopped with pharmacological means.
CONCLUSIONS: The combination of neurological symptoms, thrombocytopenia, fever, 
renal failure and hemolytic anemia in a patient taking ticlopidine points to a 
diagnosis of TTP. The high mortality of TTP can probably only be reduced by 
early plasmapheresis.