HIV-Associated Thrombotic Thrombocytopenic Purpura in a Virally Suppressed Patient With Normal CD4 Count: A Rare Presentation

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic process characterized by multiorgan failure secondary to microvascular thrombi comprising platelets and von Willebrand factor. HIV is a known risk factor for TTP. However, patients generally have low CD4+ count during initial presentation or subsequent flare-ups. This case report describes a 69-year-old man with HIV who presented with an initial presentation of TTP while having a prior history of HIV with a normal CD4 count and undetectable viral load on presentation. A 69-year-old Caucasian male with a previous history of HIV on antiretroviral therapy (ART), a history of recurrent deep vein thrombosis maintained on Coumadin, and no previous history of tobacco dependence or substance use presented to the emergency department with symptoms of fatigue and dyspnea worsening on exertion. The patient had stable vital signs on arrival. The initial lab workup was remarkable for hemoglobin of 9.3 g/dL, hematocrit 29%, platelets 22 x 10