CONTEXT: Acute pancreatitis due to thrombotic thrombocytopenic purpura is a well 
recognized condition. Here, we are reporting a rare converse phenomenon, in 
which thrombocytopenic purpura occurred secondary to acute pancreatitis.
CASE REPORT: A 19-year-old male referred to our intensive care unit with 
diagnosis of acute pancreatitis with multi-organ dysfunction. He had history of 
severe abdominal pain and recurrent vomiting about one month ago, requiring 
hospital admission. There, on diagnostic work-up at admission, abdominal 
ultrasonography was suggestive of pancreatitis. His serum amylase and lipase 
were 1,900 and 1,582 U/L, respectively. Other laboratory parameters were within 
normal limits. He was managed conservatively with intravenous fluids, 
antibiotics and analgesics; and discharged after about 2 weeks One week after 
discharge he was readmitted in same hospital with abdominal pain, multiple 
episodes of bilious vomiting and abdominal distention. Later on he was referred 
to our intensive care unit; having classical pentad of thrombocytopenic purpura, 
i.e., thrombocytopenia, micro-angiopathic hemolytic anemia, renal failure, 
encephalopathy, and fever. His condition improved with plasma exchange therapy 
and transferred out from our ICU to ward after 10 days of stay.
CONCLUSION: Thrombocytopenic purpura may be precipitate by acute pancreatitis 
due to multiple mechanisms. A high clinical suspicion is required to make an 
early diagnosis and allow early initiation of plasma exchange therapy, resulting 
in a good prognosis.