Fatal thrombotic thrombocytopenic purpura in discoid lupus

The association between TTP and systemic lupus erythematosus (SLE) has been infrequently reported, however an association with discoid lupus was not reported in the literature. Usually, patients with TTP have increased SLE activity and frequent renal involvement. Here we present a case of a 65 year old man who presented to the emergency department with malaise, fever and purpura of several days duration. His past medical history was sig- nificant for discoid lupus diagnosed by biopsy 34 years ago as well as hypertension. On laboratory investigation, he had low complement levels and ADAMTS13 level of < 5 %. A peripheral blood smear showed the presence of schistocytes. On the basis of clinical and biochemical findings, he was diagnosed with TTP.