Thrombotic thrombocytopenic purpura with delayed hematological manifestations in an atypical stroke: a case report

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disease which is often missed because of its heterogeneous presentation. A 55-year-old female presented with an atypical stroke; concurrent acute ischemic stroke and intracranial bleed with normal initial laboratory investigations. Ten days later, clinical and biochemical evolution revealed a diagnosis of TTP, representing an uncommon and atypical presentation of the condition. With prompt diagnosis and extensive workup, immediate treatment was delivered. This case highlights the challenges of diagnosing delayed and atypical presentation of TTP and stroke and its management in resource-limited settings when plasma exchange is not readily available; due to financial constraints or certain contraindications. Thus, we commenced plasma infusion and intravenous steroids, which led to sustained biochemical and clinical improvement. It highlights the critical role of prompt diagnosis, emphasizing the integration of clinical expertise, and strategic problem-solving to overcome challenges in resource-limited settings and deliver optimal outcomes in complex cases.

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