Austin P. Runde, MS; Sanchita Sen, MA; Beatriz Maria Franco Hondermann, MD; Nikitha Nelapudi, MD; Deval Patel, MD
WMJ. 2026;125(4):537-541. Published November 1, 2026.
ABSTRACT
Introduction: This case highlights the successful management of atypical, refractory thrombotic thrombocytopenic purpura (TTP), including co-occurring autoimmune conditions, treatment-related adverse effects, and disease sequelae.
Case Presentation: A Hispanic woman in her early 50s presented to the emergency department of an academic, tertiary medical center after a syncopal episode. She reported flu-like symptoms during the preceeding 2 days. Physical examination was remarkable only for scattered ecchymoses on the upper extremities and petechiae of the lower extremities. Despite her clinical stability, she was ultimately found to have refractory TTP, warm autoimmune hemolytic anemia (wAIHA), and Sjögren’s syndrome.
Discussion: No reports have described the co-occurrence of TTP, wAIHA, and Sjögren’s syndrome. Isolated case reports have described co-occurring TTP and Sjögren’s syndrome, as well as co-occurring or sequential TTP and wAIHA, with or without lupus.
Conclusions: We report what is, to our knowledge, one of the first cases of co-occurring TTP, wAIHA, and Sjögren syndrome. This case underscores the importance of multidisciplinary care in the management of refractory TTP and its associated complications.