Open AccessA rare case of malignant hypertension with splenic rupture and thrombotic microangiopathy
Author(s) -
Jiaxiang Ding,
Zhen Qu,
Feng Yu
Publication year - 2020
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000020581
Subject(s) - medicine , thrombotic microangiopathy , splenectomy , hemodialysis , microangiopathy , surgery , complication , abdominal pain , spleen , diabetes mellitus , disease , endocrinology
Thrombotic microangiopathy (TMA) is characterized by endothelial injury followed by formation of multiple microthrombi in the target organs due to various causes, including malignant hypertension (MHT). Here, we reported a rare case of MHT with splenic TMA changes. Case concerns: A 27-year-old Chinese Han male with a history of hypertension and proteinuria, admitted to our hospital because of renal failure with MHT and thrombocytopenia. Diagnosis: This case diagnosed with TMA based on the patient's MHT and thrombocytopenia. The patient final diagnosis was confirmed by the spleen pathological findings, other differential diagnoses were ruled out. Interventions: The patient was treated with hemodialysis and intravenous antihypertensive agents, and his condition gradually improved. However, he suddenly complained of abdominal pain and went into hemorrhagic shock, which was due to spontaneous spleen rupture on the third day of hospitalization. The pathological evidence after splenectomy showed splenic TMA. Outcomes: Hemodialysis was continued and the blood pressure was under control until his discharge from our hospital. Conclusion: Spontaneous splenic rupture could be a rare and critical complication associated with MHT-induced TMA, and it requires careful clinical attention.