A Case of HIV Infection with Thrombocytopenia: Assosiation of HIV, Thrombotic Thrombocytopenic Purpura and Brucellosis

  • Behice Kurtaran
  • Ozgur Akin Oto
  • Aslihan Candevir
  • Ayse Seza Inal
  • Yusuf Sirin
Case Report


To report a case of HIV infection presenting with thrombotic thrombocytopenic purpura (TTP) and brucellosis that responded well to plasmapheresis and anti-infective therapy. A 64-year-old woman with moderate confusion, fever and pancytopenia was admitted. HIV infection history was taken from her family and she was not receiving antiretroviral therapy last one year. She had generalized purpuric skin lesions. Wright tube agglutination test was found positive with a 1:160 dilution and the patient was diagnosed as brucellosis. Detailed literature search showed brucellosis as a possible cause of TTP. Patient was treated by plasma exchange/fresh frozen plasma and antimicrobials and the response was excellent. Although brucellosis seems to explain the clinical picture of this patient, it is revealed that broad differential diagnosis is needed to reach uncommon diagnosis like TTP particularly in HIV infected patients.


HIV Brucellosis Thrombotic thrombocytopenic purpura Plasma exchange 


  1. 1.
    Veyradier A, Meyer D (2005) Thrombotic thrombocytopenic purpura and its diagnosis. J Thromb Haemost 3:2420–2427CrossRefPubMedGoogle Scholar
  2. 2.
    Erdem F, Kiki I, Gündoğdu M, Kaya H (2007) Thrombotic thrombocytopenic purpura in a patient with Brucella infection is highly responsive to combined plasma infusion and antimicrobial therapy. Med Princ Pract 16:324–326CrossRefPubMedGoogle Scholar
  3. 3.
    Thrombotic thrombocytopenic purpura and HIV NIH guide, Volume 23(36), October 14, 1994Google Scholar
  4. 4.
    Aliskan H (2008) The value of culture and seological methods in the diagnosis of human brucellosis. Microbiyol Bul 42(1):185–195Google Scholar
  5. 5.
    Naz H, Aykin N, Cevik F, Bal C (2009) Brucellosis in central Anatolia: evaluation of complications and relapse. Trop Dr 39(2):107–109CrossRefGoogle Scholar
  6. 6.
    Ozisik HI, Ersoy Y, Refik Tevfik M, Kizkin S, Ozcan C (2004) Isolated intracranial hypertension: a rare presentation of neurobrucellosis. Microbes Infect 6:861–863CrossRefPubMedGoogle Scholar
  7. 7.
    Heydari F, Mozaffari NA, Tukmechi A (2008) Comparison of standard seroaglutination tests and ELISA for diagnosis of brucellosis in West Azerbaijan Province, Iran. Res J Biol Sci 3(12):1460–1462Google Scholar
  8. 8.
    Soker M, Devecioglu C, Yaramis A, Ipek S, Ozbek MN, Tüzün H (2001) Microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure associated with acute brucellosis. Intern Pediatr 16(2):105–108Google Scholar
  9. 9.
    Di Mario A, Sica S, Zini G, Salutari P, Leone G (1995) Microangiopathic hemolytic anemia and severe thrombocytopenia in Brucella infection. Ann Hematol 70:59–60PubMedGoogle Scholar
  10. 10.
    Al-Eissa Y, al-Nasser M (1993) Hematological manifestations of childhood brucellosis. Infection 21:23–26CrossRefPubMedGoogle Scholar
  11. 11.
    Calvo Villas JM, Queizan Hernandez JA, Moreno Palomares FJ, Soto Guzman O (1997) Microangiopathic hemolytic anemia associated with acute brucellosis. Med Clin (Barc) 109:236Google Scholar
  12. 12.
    Moake JL (2002) Thrombotic microangiopathies. N Engl J Med 347:589–600CrossRefPubMedGoogle Scholar
  13. 13.
    Ruggenenti P, Remuzzi G (1998) Pathophysiology and management of thrombotic microangiopathies. J Nephrol 11:300–310PubMedGoogle Scholar
  14. 14.
    Cruccu V, Parisio E, Pedretti D, Villa A, Confalonieri F (1994) HIV-related thrombotic thrombocytopenic purpura (TTP) as first clinical manifestation of infection. Haematologica 79:277–279PubMedGoogle Scholar
  15. 15.
    Moake JL, McPherson PD (1989) Abnormalities of von Willebrand factor multimers in thrombotic thrombocytopenic purpura and the hemolytic-uremic syndrome. Am J Med 87:9–15CrossRefGoogle Scholar

Copyright information

© Indian Society of Haematology & Transfusion Medicine 2011

Authors and Affiliations

  • Behice Kurtaran
    • 1
  • Ozgur Akin Oto
    • 2
  • Aslihan Candevir
    • 1
  • Ayse Seza Inal
    • 1
  • Yusuf Sirin
    • 3
  1. 1.Infectious Disease Department, Faculty of MedicineCukurova UniversityAdanaTurkey
  2. 2.Internal Medicine DepartmentPrivate Care HospitalCeyhanTurkey
  3. 3.Internal Medicine Department, Faculty of MedicineCukurova UniversityAdanaTurkey

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