Abstract
An 82-year-old man was referred to our hospital because of high fever, nausea and vomiting. Laboratory data showed BUN 118mg/dL, serum creatinine (Cr) 8.0mg/dL, LDH 2, 195U/L and platelet count 4.1×104/mm3. Acute renal failure due to hemolytic uremic syndrome (HUS)/thrombotic thrombocytopenic purpura (TTP) was diagnosed. Following hemodialysis (HD) and plasma exchange (PEx), renal function and platelet count returned to normal. Ten days later, Cr had increased to 2.2mg/dL and platelet count had decreased to 110, 000/mm3, Indicating that HUS/TTP had recurred. A relationship between cryoglobulinemia (Cryo) and HUS/TTP was suspected, as Cryo plus positive HCV was accompanied with hypocomplementemia. After cryofiltration, both PEx and HD were performed, achieving a further remission. There has not been any obvious recurrence of HUS/TTP since combination therapy with predonisone and cyclophosphamide was performed to make Cryo negative.
In this case, HUS/TTP associated with cryoglobulinemia and positive HCV was suspected, although there are few reports of the association between HUS/TTP and cryoglobulinemia. PEx was thought to be an effective therapeutic strategy even in HUS/TTP related to cryoglobulinemia. The combination of glycocorticoid and immunosuppressant caused his complement to become normal and his Cryo negative, as well as preventing the recurrence of HUS/TTP.
