COVID-19 associated thrombotic thrombocytopenic purpura: a case report and review of the literature.

Abstract

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially life-threatening complication whose association with COVID-19 is controversial. Understanding this connection is essential due to its significant impact on patient outcomes, and timely diagnosis and intervention are critical in managing this condition effectively.

Areas covered: This paper presents a case of TTP triggered by COVID-19 infection in a 48-year-old female. Additionally, a comprehensive literature review was conducted using PubMed and Google Scholar databases, from inception through August 2024, to identify all published cases of COVID-19-associated TTP. The literature search focused on adult cases of TTP secondary to COVID-19 infection, highlighting the treatments used and patient outcomes.

Expert opinion: In this report, we highlight the importance of recognizing TTP as a possible complication of COVID-19. While the standard treatment for TTP - plasma exchange and corticosteroids - remains the primary approach, we note that COVID-19-related cases exhibit a high risk of early relapse, as seen in our patient. The literature review suggests that TTP triggered by COVID-19 may have unique characteristics, such as a persistent low ADAMTS13 activity and increased relapse rates. Larger studies are necessary to develop optimal treatment guidelines and understand whether the presence of COVID-19 alters the typical clinical course of TTP.