Altered Mental Status in the Setting of Thrombotic Thrombocytopenic Purpura (TTP) and Spontaneous Coronary Artery Dissection (SCAD): A Case Report and Literature Review.

Altered mental status (AMS) is a common condition encountered in daily practice. Finding the cause is essential for treatment, but sometimes this may be challenging. Spontaneous coronary artery dissection (SCAD) is frequently underdiagnosed and is a potentially fatal cause of acute coronary syndrome. Clinical presentation depends on the extent of SCAD, ranging from unstable angina to sudden death. AMS has not been reported with this condition, but it may be possible in hypoperfusion states. Thrombotic thrombocytopenic purpura (TTP) is part of the microangiopathic hemolytic anemia (MAHA) spectrum, presenting with AMS as the cardinal symptom. TTP is a clinical emergency, and a high index of suspicion should be present as the mortality rate in untreated patients is extremely high and can be significantly reduced with proper treatment. We present a case of a 44-year-old female with a past medical history of antiphospholipid syndrome not on anticoagulation, peptic ulcer disease, chronic kidney disease, stroke, seizures, congestive heart failure with reduced ejection fraction (EF 40%), two non-ST-segment elevation myocardial infarctions not on dual antiplatelet therapy due to a history of gastrointestinal bleeding, and TTP, admitted to the hospital with AMS. The patient was diagnosed with two life-threatening pathologies with overlapping features but opposing management; TTP may have been caused by SCAD, even though this has never been reported. It is essential to recognize that while a single diagnosis frequently explains a patient's clinical manifestations, there are instances when various conditions may be present.

A Paradox Unveiled: A Case Report of Cerebral Infarctions in a Patient With Severe Thrombocytopenia.

Thrombocytopenia is a condition in which the platelet count is less than 150,000/µL, which can be congenital or acquired. The condition can be further sub-classified. Nevertheless, the causes include infection, medication-mediated, liver diseases, or heart diseases. Moreover, diagnosis is straightforward only on a few occasions. Here, we are presenting a patient with a conundrum of immune thrombocytopenia (ITP) and a stroke. A 75-year-old female patient with a past medical history of hypertension was brought to the emergency department (ED) for altered mental status (AMS). Initial blood workup showed a platelet count of 27,000/µL and hemoglobin level of 6.2 g/dl, and brain magnetic resonance imaging (MRI) revealed ischemic stroke. Rarely, ITP patients can paradoxically develop arterial and venous thrombosis. Hence, physicians must remain vigilant in promptly and accurately diagnosing thrombotic events in ITP to ensure appropriate treatment, including antiplatelet and anticoagulant therapy, alongside ITP-specific interventions to improve outcomes.

A Case Report of Cold Agglutinin Disease, Severe B12 Deficiency, and Pernicious Anemia: A Deadly Coincidence.

Anemia is the most common hematological disorder. It is commonly a manifestation of an underlying disease. Its causes are multifactorial, including but not limited to nutritional deficiencies, chronic conditions, inflammatory processes, medications, malignancy, renal dysfunction, hereditary diseases, and bone marrow disorders. We present a case of a patient exhibiting anemia related to cold agglutin disease and severe B12 deficiency secondary to pernicious anemia.