alexa Hemorrhagic Stroke in an Adolescent Female with HIV-Ass
ISSN 2155-6113

Journal of AIDS & Clinical Research
Open Access

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Case Report

Hemorrhagic Stroke in an Adolescent Female with HIV-Associated Thrombotic Thrombocytopenic Purpura

Natella Rakhmanina1,4, Edward CC Wong2,4,5, Jeremiah C Davis6 and Patricio E Ray3,4*

1Divisions of Infectious Disease, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA

2Laboratory Medicine, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA

3Children’s National Medical Center, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA

4Departments of Pediatrics, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA

5The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA

6Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle WA, USA

*Corresponding Author:
Patricio E Ray M.D.
Professor of Pediatrics
The George Washington University
Children's National Medical Center 111 Michigan Avenue
NW, Washington, DC 20010, USA
Tel: (202) 476-2912
Fax: (202) 476-4477
E-mail: [email protected]

Received Date: March 31, 2014; Accepted Date: May 26, 2014; Published Date: June 06, 2014

Citation: Rakhmanina N, Wong ECC, Davis JC, Ray PE (2014) Hemorrhagic Stroke in an Adolescent Female with HIV-Associated Thrombotic Thrombocytopenic Purpura. J AIDS Clin Res 5:311. doi:10.4172/2155-6113.1000311

Copyright: © 2014 Rakhmanina N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

Abstract

HIV-1 infection can trigger acute episodes of Idiopathic Thrombocytoponic Purpura (ITP), and Thrombotic Thrombocytopenic Purpura (TTP), particularly in populations with advanced disease and poor adherence to antiretroviral therapy (ART). These diseases should be distinguished because they respond to different treatments. Previous studies done in adults with HIV-TTP have recommended the prompt initiation or re-initiation of ART in parallel with plasma exchange therapy to improve the clinical outcome of these patients. Here, we describe a case of HIVTTP resulting in an acute hemorrhagic stroke in a 16 year old female with perinatally acquired HIV infection and non-adherence to ART, who presented with severe thrombocytopenia, microangiopathic hemolytic anemia, and a past medical history of HIV-ITP. Both differential diagnosis and treatments for HIV-ITP and HIV-TTP were considered simultaneously. A decrease in plasma ADAMTS13 activity (<5%) without detectable inhibitory antibodies confirmed the diagnosis of HIV-TTP. Re-initiation of ART and plasma exchange resulted in a marked decrease in the HIV-RNA viral load, recovery of the platelet count, and complete recovery was achieved with sustained virologic suppression.

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