PMC4532017_01
Peripheral blood smear. Mild poikilocytosis is seen with some schistocytes and helmet cells. Platelets are markedly decreased in number with some young platelets (Wright stainx1000).
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The blood smear revealed several fragmented red cells and scarcity of platelets (Fig. 1).
Bone marrow biopsy. Arterioles and venules are prominent and endothelial cell proliferation of vessels is noted with suspicious microthrombi in the lumen (arrow) (HE stainx400).
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Clinical features and laboratory findings at first admission.
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Aphasia gradually improved, and after 21 sessions of plasmapheresis lasting 36 days (10-20 units of fresh frozen plasma replacement per session) he fully recovered from neurologic deficit and became afebrile (Fig. 3).
Kidney biopsy. A slightly enlarged glomerulus, showing diffuse thickening of glomerular basement membrane and mesangial interposition (solid arrow). Note focal and segmental mesangial expansion and equivocal hyper-cellularity (open arrow) (PA-silver stain).
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A renal biopsy revealed diffuse proliferative glomerulonephritis (Fig. 4).
Clinical features and laboratory findings at second admission.
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After 3 sessions in 4 days, the patient improved with no fever and no neurologic abnormality (Fig. 5).