A rare manifestation presenting as acute pancreatitis of thrombotic thrombocytopenic purpura

Thrombotic thrombocytopenic purpura (TTP) is an unusual disease with a 90% mortality rate without prompt management. The typical clinical manifestations include thrombocytopenia, hemolytic anemia, neurological symptoms, fever, and renal impairment. However, recognizing TTP in its early stages is not always easy due to limited clinical experience and sometimes atypical presentation. We report a 44-year-old male who initially suffered from jaundice and skin purpura, followed by epigastric pain. Acute pancreatitis was first suspected after a computerized tomography (CT) scan in the local medical department, without a definite etiology. He was then transferred to our hospital for further investigation of hemolysis. Transient neurological symptoms occurred 1 week after transferring. TTP was later confirmed based on schistocytes noted in peripheral blood smear and ADAMTS-13 activity = 0%. The patient was discharged successfully after prompt therapeutic plasma exchange and steroid treatment. We present the first case of TTP inducing acute pancreatitis in Asia and remind that acute pancreatitis is a possible cause of abdominal pain, although it's a rare manifestation of TTP.