# Small Bowel Ischemia and Ischemic Colitis Secondary to Thrombotic Thrombocytopenic Purpura in a Patient With Systemic Lupus Erythematous: A Rare Clinical Entity

## TL;DR

A rare case of TTP causing bowel ischemia in a patient with lupus highlights the need for early diagnosis and treatment to improve outcomes.

## Contribution

This case report presents a rare clinical manifestation of TTP in a systemic lupus erythematosus patient with end-stage renal disease.

## Key findings

- TTP caused small bowel ischemia and ischemic colitis in a 35-year-old woman with SLE.
- Plasma exchange, steroids, and rituximab failed, but surgical resection improved clinical outcomes.
- Early recognition of TTP in SLE patients is critical to reduce morbidity and mortality.

## Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening hematologic disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ dysfunction. This report highlights a rare case of small bowel ischemia and ischemic colitis caused by TTP in a 35-year-old woman with systemic lupus erythematosus (SLE), hypertension, and end-stage renal disease on hemodialysis. She presented with severe abdominal pain, diarrhea, vomiting, and bloody bowel movements. Diagnosed through CT, EGD, and colonoscopy and confirmed by ADAMTS13 levels, she was treated with plasma exchange, steroids, and rituximab. After standard therapies failed, resection anastomosis surgery led to clinical improvement. This case underscores the importance of early recognition and treatment of TTP in SLE patients to improve prognosis and reduce morbidity and mortality.