Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2021; 9(27): 8104-8113
Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8104
Acute myocardial infarction and extensive systemic thrombosis in thrombotic thrombocytopenic purpura: A case report and review of literature
Delia Lidia Șalaru, Cristina Andreea Adam, Dragos Traian Marius Marcu, Ionut Valentin Șimon, Liviu Macovei, Lucian Ambrosie, Elena Chirita, Radu Andy Sascau, Cristian Statescu
Delia Lidia Șalaru, Cristina Andreea Adam, Dragos Traian Marius Marcu, Liviu Macovei, Radu Andy Sascau, Cristian Statescu, Department of Cardiology, Institute of Cardiovascular Diseases, “Prof. Dr. George I.M. Georgescu,” Iasi 700503, Romania
Delia Lidia Șalaru, Dragos Traian Marius Marcu, Liviu Macovei, Radu Andy Sascau, Cristian Statescu, Internal Medicine, University of Medicine and Pharmacy, ”Grigore T. Popa Iași, Romania,” Iasi 700115, Romania
Lucian Ambrosie, Elena Chirita, General Surgery, ”Sf. Spiridon” Emergency Hospital Iasi, Iasi 700111, Romania
Author contributions: Șalaru DL and Adam CA contributed equally to this work; Ambrosie L and Chirita E performed the surgery; Șalaru DL and Adam CA wrote the paper; Șimon IV and Marcu DTM helped revise the language and review editing; Macovei L was the patient’s doctor; Macovei L, Sascau RA, and Statescu C selected the figures and revised the final script.
Informed consent statement: Written informed consent was obtained from the patient or his/her guardians prior to the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Cristina Andreea Adam, MD, Doctor, Department of Cardiology, Institute of Cardiovascular Diseases, “Prof. Dr. George I.M. Georgescu”, Blvd. Carol I, No. 50, Iasi 700503, Romania.
Received: May 7, 2021
Peer-review started: May 7, 2021
First decision: June 6, 2021
Revised: June 19, 2021
Accepted: July 27, 2021
Article in press: July 27, 2021
Published online: September 26, 2021

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy characterized by the pentad of hemolytic anemia, fever, thrombocytopenia, renal failure, and neurological dysfunction. The formation of microthrombi in the arterioles and capillaries of various organs is one of the main pathophysiological mechanisms. Clinical manifestations of cardiac involvement in TTP patients are variable. Acute myocardial infarction has been reported as a complication with TTP as the secondary thrombotic event. Its emergence as the initial thrombotic event is extremely rare.


A 49-year-old previously healthy man was admitted for fever, typical angina chest pain 3 d prior to presentation, and newly onset left lower limb pain. The electrocardiogram illustrated ST-elevation acute myocardial infarction of the antero-lateral wall of the left ventricle. Transthoracic echocardiography depicted two large thrombi at the apex of the left ventricle and moderately reduced ejection fraction (40%). Venous Doppler ultrasound showed occlusion of the left popliteal artery. Laboratory tests showed severe thrombocytopenia, mild hemolytic anemia, elevated D-dimers, and high troponin and creatine kinase-MB. Abdominal computed tomography revealed other thrombotic sites (superior mesenteric artery, posterior aortic wall, spleen and renal infarction, and ileum necrosis). He was immediately started on steroids and addressed to surgery for acute abdominal pain. After an initial stabilization of the hematological deficit, he went into general surgery for resection of the necrotic ileum but died soon after the intervention due to multiple organ failure.


Cardiac involvement in TTP patients is common, challenging and more often fatal, especially when other thrombotic complications coexist.

Keywords: Thrombotic thrombocytopenic purpura, Acute myocardial infarction, Limb ischemia, Systemic thrombosis, Review, Case report

Core Tip: Physicians should be vigilant regarding the possible diagnosis of thrombotic thrombocytopenic purpura when identifying multiple thrombotic sites in the context of an acute myocardial infarction associated with thrombocytopenia. At the moment of diagnosis, plasma exchange with fresh frozen plasma replacement and immunosuppression with corticosteroids should be considered. The prognosis is severe.