Severe Plasmodium Falciparum Malaria Mimicking Thrombotic Thrombocytopenic Purpura (TTP): A Case Report From China

Plasmodium falciparum Malaria and Thrombocytopenic Purpura (TTP) are serious diseases associated with thrombotic microangiopathic anemia (TMA) pathogenesis. Therefore, clinical treatment is usually delayed because of the overlapping clinical manifestations. This case describes Plasmodium falciparus infection causing markedly elevated von Willebrand factor (vWF) levels but normal ADAMTS13 activity, which closely mimics the presentation of TTP. There is overlap in laboratory and clinical presentations, such as fever, thrombocytopenia, severe anemia, and intravascular coagulation between malaria and TTP. We present the case of a 51-year-old Chinese man who initially presented with fever that quickly progressed to a disturbance of consciousness. Laboratory tests showed a decreased platelet count, elevated lactate levels, and elevated indirect bilirubin levels. The patient's PLASMIC score for TTP was 7, suggesting a high possibility of TTP. There was markedly elevated vWF, but normal ADAMTS13 activity. Therefore, TTP was excluded. However, we found a large amount of P. falciparus in the peripheral blood smears. The patient's condition gradually improved after intravenous artesunate treatment. Malaria and TTP have obvious laboratory and clinical resemblances, owing to the presence of TMA. It is important to quickly perform a differential laboratory diagnosis between malaria and TTP, which may lead to the early initiation of lifesaving treatment in some patients.