Recurrent thrombotic thrombocytopenic purpura after viral infection. Clinical and histologic simulation of chronic glomerulonephritis.

We describe a patient with recurrent thrombotic thrombocytopenic purpura (TTP) manifested solely by aphasia after influenza infection. The clinical diagnosis was not made during acute episodes, and during the intercurrent period the patient had features of chronic glomerular disease, including hypertension, proteinuria, RBC casts, and a nonspecific renal histological appearance. A final episode of aphasia, acute renal failure, and microangiopathic anemia and thrombocytopenia made the diagnosis of TTP apparent. Chronic glomerular disease may in rare instances be a manifestation of occult TTP or the sequel of a prior acute episode of this disorder.