Abstract
A 79-year-old man was admitted to another hospital in January 201X due to fever and eruptions. He was diagnosed with toxicodermatitis and was discharged from the hospital after steroid therapy. In April 201X, he was admitted to the hospital for thrombocytopenia, but was transferred to our hospital on suspicion of hematologic disease because of the appearance of anemia and disturbance of consciousness. Because he had thrombocytopenia, hemolytic anemia and mental confusion, he was suspected to have thrombotic thrombocytopenic purpura and immediately received plasma exchange and high-dose steroid therapy. A deficiency in ADAMTS13 activity confirmed the diagnosis of TTP later. Although improving temporarily, his laboratory tests showed recurrence of thrombocytopenia and he was administered cyclophosphamide and rituximab. Because his platelet count became stable after starting the combination therapy, PE was stopped and he was discharged from the hospital with oral steroid therapy. It was shown that rituximab and cyclophosphamide should be considered with refractory TTP.
