Abstract
The patient was a 2-year-old boy, who had fever and pharyngeal pain from 9 days before admission and developed vomiting and diarrhea from a day before admission. He had a depressed level of consciousness, and developed cardiac arrest while being transferred to a neighborhood clinic by his family. After advanced cardiac life support was performed at this clinic, he regained heartbeat and respiration, but did not regain consciousness, and thus was referred to our hospital. Since hemolytic uremic syndrome was suspected at first, intensive care, including continuous hemodiafiltration and brain hypothermia, was started. On admission, fecal cultures revealed Escherichia coli O-1, but no verotoxin. The platelet count did not improve despite frequent platelet transfusions. Therefore, TTP was suspected, and thus plasma exchange was performed on the 11th and 12th ICU days. On the 15th ICU day, TTP was diagnosed by markedly decreased activity of a disintegrin and metalloproteinase with thrombospondin type 1 motif, number 13 and by the presence of antibody to this protease. Subsequently, the patient's general condition improved, and he was discharged from the ICU on the 20th ICU day.
