Abstract
We describe a 38-y-old female with chronic renal failure who was diagnosed with thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), and thereafter developed posterior reversible encephalopathy syndrome (PRES). She was admitted to our hospital because of high fever and a neck lymphnode swelling. After the infection, she demonstrated five typical signs of TTP except neurological abnormalities, that is, high fever, severe thrombocytopenia, hemolytic anemia and renal failure. Therefore, we initiated plasma exchange with steroid therapy for TTP. Shortly after blood transfusion for severe hemolytic anemia, she was complicated by accelerated high blood pressure and epilepsy. Plasma exchange therapy was performed 29 times till these symptoms of TTP/HUS were controlled. Reversible findings on brain magnetic resonance imaging (MRI) as well as the reversible neurological signs were consistent with PRES.
Blood transfusion may have contributed to the pathogenesis of PRES through altered vascular dynamics.
