期刊
INTERNAL MEDICINE
卷 50, 期 6, 页码 643-647出版社
JAPAN SOC INTERNAL MEDICINE
DOI: 10.2169/internalmedicine.50.4620
关键词
swine influenza; TMA; cytokine storm; UL-VWFM; ADAMTS13
资金
- Ministry of Education, Culture, Sports, Science and Technology of Japan
- Ministry of Health, Labor, and Welfare of Japan
We describe an 18-year-old woman infected with H1N1 influenza followed by thrombotic microangiopathy. During the acute phase, her plasma levels of von Willebrand factor (VWF) were remarkably elevated, whereas those of ADAMTS13 were reduced without its inhibitors, generating a markedly high ratio of VWF to ADAMTS13 in circulation. A retrospective analysis established the following hypothesis: an influenza-mediated cytokine storm induced an enhanced release of unusually large VWF multimers (UL-VWFM) from vascular endothelial cells, generating platelet thrombi in microcirculatures under high shear stress. Plasma exchange removed UL-VWFM and cytokines, and rescued her life. This report sheds a light on a hitherto unrecognized influenza complication.
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