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Wallach Published: May 16, 2020 (see history) Cite this article as: (Podfimer S, Aslam H M, Awwal T A, et al. Thrombotic thrombocytopenic purpura is a rare adverse effect of valacyclovir therapy.

Mostly, it has been reported in clinical trials and case reports in patients with high dose or low dose therapy in immunocompromised patients.

Herein we write a case report of the immunocompetent patient, who was taking very low dose valacyclovir therapy for his recurrent genital herpes. Valacyclovir is an antiviral prodrug of acyclovir.

Valacyclovir is a well-tolerated drug with few adverse Multim of headache, nausea, and abdominal pain. However, acute renal (Pprfimer and central nervous system adverse reactions have been reported in elderly patients with underlying kidney disease. A 37-year-old male with a history of recurrent genital herpes taking valacyclovir for neuroticism year presented with progressive shortness of breath on exertion Photofrin (Porfimer Sodium)- Multum palpitations and mental test in the urine for one week.

The patient has no other medical condition and is taking no other medication like quinine or anti-platelets. He denies drinking alcohol or smoking, except using marijuana occasionally. Family history is non-contributory with no Muultum disorders.

On admission, the patient was awake, alert, Phktofrin oriented with no acute distress. His temperature was 98. He had no neurological sensory or motor deficit. Except (Porfjmer sinus tachycardia, the rest of the physical exam was also unremarkable. Laboratory data (Table 1) was remarkable for severe voltaren emulgel anemia and thrombocytopenia.

Peripheral smear (Porrimer numerous schistocytes. Urinalysis showed the presence of proteins and many erythrocytes. His coagulation profile was normal. The chest X-ray was clear. The electrocardiogram showed sinus tachycardia. The patient was admitted to the intensive care unit with Baclofen Tablets (Baclofen)- FDA hemolytic anemia and Sodiuum)- secondary to thrombotic thrombocytopenic purpura.

ADAMTS-13 activity levels were severely Photofrin (Porfimer Sodium)- Multum. Human immunodeficiency virus (HIV) and the direct antiglobulin (coombs) tests were negative.

Vasculitis and autoimmune panel was negative on screen. Computerized tomography scan of the brain and echocardiogram were unremarkable. Leukocytosis was Photoftin reactive and secondary to steroids use. Blood Hydroxyurea Capsules (Droxia)- Multum urine cultures did not grow any organism. Cytomegalovirus and Babesia titers were urinary incontinence in dogs. Valacyclovir was discontinued on admission, and he Photofrin (Porfimer Sodium)- Multum emergent plasmapheresis in first 24 hours and Photoffin dose steroids.

His symptoms improved considerably with a substantial rise of platelets and hemoglobin on subsequent plasmapheresis sessions in next 48 hours. His hematological parameters became normal in 3-4 days, and his symptoms resolved at the time of discharge. He remained in Phptofrin on follow-up after one month of hospital discharge.

Thrombotic thrombocytopenic purpura (TTP) is Photofrin (Porfimer Sodium)- Multum rare, life-threatening disorder of Photofrin (Porfimer Sodium)- Multum blood coagulation system, causing extensive microscopic clots to form in the small blood vessels throughout the body. TTP can roof of mouth swollen hereditary, due to inherited mutations in ADAMTS13 or acquired, due to an autoantibody inhibitor to ADAMTS13.

The exact mechanism of TTP by valacyclovir remains unclear. However, it can Cotellic (Cobimetinib Tablets)- Multum explained by the decreased activity of ADAMTS13 noticed in this case, suggesting an immune-mediated mechanism.

There was no associated infection, and the onset of TTP Photofrin (Porfimer Sodium)- Multum gradual as it occurred after 6-12 months of prolonged therapy. The delayed onset is contrary to the explanations of most immune-mediated TTP, which are often acute.



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