Thrombotic thrombocytopenic purpura following salvage chemotherapy with paclitaxel, ifosfamide and cisplatin in a patient with a refractory germ cell tumor: A case report and review of the literature

Ulas,Arife; Silay,Kamile; Akinci,Sema; Akinci,Muhammed  Bulent; Sendur,Mehmet  Ali; Dede,Didem  Sener; Polat,Yunus  Halil; Yalcin,Bulent

doi:10.3892/ol.2015.3338

Thrombotic thrombocytopenic purpura following salvage chemotherapy with paclitaxel, ifosfamide and cisplatin in a patient with a refractory germ cell tumor: A case report and review of the literature

Authors:
- Arife Ulas
- Kamile Silay
- Sema Akinci
- Muhammed Bulent Akinci
- Mehmet Ali Sendur
- Didem Sener Dede
- Yunus Halil Polat
- Bulent Yalcin
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Affiliations: Department of Medical Oncology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey, Department of Geriatrics, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey, Department of Hematology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey, Department of Medical Oncology, Yildirim Beyazit University, Ankara, Turkey, Department of Internal Medicine, Yildirim Beyazit University, Ankara, Turkey
Published online on: June 8, 2015 https://doi.org/10.3892/ol.2015.3338
Pages: 2223-2226

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Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare form of thrombotic microangiopathy that is characterized by microvascular thrombosis, thrombocytopenia, hemolysis and end organ damage. An extensive variety of drugs, including certain chemotherapeutic agents, have been associated with TTP. However, paclitaxel, cisplatin and ifosfamide regimen (TIP)‑induced TTP has not previously been described. The present study reports the case of a 43‑year‑old patient with a refractory testicular germ cell tumor who developed acute TTP during TIP chemotherapy. Following the third cycle of TIP chemotherapy, the patient developed fever, anemia, thrombocytopenia and confusion. A diagnosis of TTP was established. Plasmapheresis was initiated as daily treatment in the first week, then continued every other day for 4 weeks. TIP chemotherapy was discontinued. The patient's clinical and neurological symptoms improved markedly after a week. Renal function and hemolysis improved, and the patient was discharged in a stable condition. The patient did not develop any complications and has been in remission for 5 months. The Naranjo adverse drug reaction probability scale indicated a likely association between TTP and the TIP chemotherapy regimen in this patient. This case is also investigated with regard to the associated literature to increase the awareness of TTP following chemotherapy.

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