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Article in Japanese
Abstract
Case Report
A case of secondary thrombotic thrombocytopenic purpura with concomitant Legionella pneumonia during the treatment of rheumatoid arthritis with adalimumab
Yumi Nishiharaa Yukimasa Kanemitsub Toshikatsu Sadoa Yuko Katayamaa Hiroko Fukataa Hideo Kitaa
aDepartment of Respiratory Medicine, Takatsuki Red Cross Hospital
bDepartment of Respiratory Medicine, Kyoto University Hospital
ABSTRACT
The patient was a 62-year-old man who developed severe antibiotic-refractory pneumonia during the treatment of rheumatoid arthritis with adalimumab. Emergent intratracheal intubation was conducted because of severe respiratory failure he had on admission. The platelet count was found to be markedly decreased without abnormality of hemostasis. Legionella' pneumonia was diagnosed based on the observation of bacilli in Gimenez-stained specimens of aspirated sputum. Plasmapheresis was performed when a diagnosis of thrombotic thrombocytopenic purpura (TTP) was made on the basis of the five classic signs. He tended to get better temporarily, but died from such complications as tension pneumothorax. Severe infection can be associated with secondary TTP, which should be differentiated from disseminated intravascular coagulation because TTP needs to be promptly treated with plasmapheresis.
KEYWORDS
Legionella pneumonia Thrombotic thrombocytopenic purpura Plasma exchange Adalimumab
Received 7 Feb 2013 ／ Accepted 26 Apr 2013
AJRS, 2(5): 598-602, 2013
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