Presentation:A 14-year-old female presented to the emergency department with a five-day history of abdominal pain and vomiting. Amylase was raised on admission and she was managed conservatively for presumed acute pancreatitis. Her condition did not improve and she deteriorated a number of days into admission and developed bilious vomiting. Diagnosis:CT abdomen-pelvis showed trichobezoars in the stomach and duodenum. Treatment:She underwent emergent laparotomy and manual removal of bezoars in a tertiary centre followed by multi-disciplinary input post-operatively. Discussion:Atypical abdominal pain in the paediatric population not responding to initial treatment warrants review of diagnosis and further investigation with consideration for early tertiary service input.
Presentation:A previously healthy woman in her mid-40s of African ancestry presented with sudden-onset left-sided weakness, aphasia, and collapse. On arrival, she was disoriented with a fluctuating GCS of 9-11. Neurological assessment revealed speech impairment and limb weakness. Diagnosis:CT brain showed multifocal parietal and cerebellar infarctions. Laboratory tests revealed severe thrombocytopenia (20 × 10³/mm³), anaemia (Hb 9 g/dL), elevated creatinine (180 μmol/L), and high troponins (1139 ng/L). Peripheral smear confirmed red cell fragmentation, and ADAMTS13 activity was <10%, confirming fulminant Thrombotic Thrombocytopenic Purpura (TTP). Treatment:Thrombolysis was contraindicated due to profound thrombocytopenia, and intensive supportive care was initiated, including vasopressors, transfusions, and planned plasma exchange. Despite aggressive management, she developed hemodynamic collapse and died within 24 hours. Discussion:This case highlights fulminant TTP mimicking acute stroke, emphasizing the importance of early recognition in patients with severe thrombocytopenia. Prompt multidisciplinary intervention and TTP-specific therapy are essential to improve survival outcomes.
