A 55-year-old female patient with ovarian cancer received bevacizumab (intravenous infusion of 400 mg on day 1) and paclitaxel liposomes (intravenous infusion of 180 mg on day 1) 9 years after surgery due to disease progression, with 21 days as a cycle of chemotherapy. Due to the improvement of the patient′s general condition, the chemotherapy regimens for the 3rd and 4th cycles were adjusted to addtionally give intravenous infusion of carboplatin 500 mg on day 1, and in the 5th cycle, the dose of bevacizumab was increased to 700 mg. Starting from the 2th cycle of chemotherapy, after each intravenous infusion of paclitaxel, the patient immediately experienced itching symptoms on the distal skin of both upper limbs, which were mild and could be relieved on their own. After the 5th cycle of chemotherapy, the patient′s itching symptoms worsened progressively. Four days later, keratinization of the skin on both hands and forearms of upper limbs appeared, with tight skin and waxy luster, gradually developing towards the proximal end. The modified Rodnan skin score was 1-2 (mild to moderate skin thickening). Laboratory tests showed positive results for anti-nuclear antibodies and anti-centromere antibodies.Pathological examination of skin biopsy tissue of the right forearm showed dermal fibrosis, involving subcutaneous adipose tissue and epidermal atrophy. It was considered to be localized cutaneous systemic sclerosis caused by paclitaxel liposomes. Paclitaxel liposomes was stopped and anti-inflammatory and topical application of glucocorticoids locally treatments were given for 3 days, the patient′s itching symptoms were improved. At a 2-month follow-up, the patient′s itching symptoms were improved and did not recur.

A 55-year-old female patient with ovarian cancer received bevacizumab (intravenous infusion of 400 mg on day 1) and paclitaxel liposomes (intravenous infusion of 180 mg on day 1) 9 years after surgery due to disease progression, with 21 days as a cycle of chemotherapy. Due to the improvement of the patient′s general condition, the chemotherapy regimens for the 3rd and 4th cycles were adjusted to addtionally give intravenous infusion of carboplatin 500 mg on day 1, and in the 5th cycle, the dose of bevacizumab was increased to 700 mg. Starting from the 2th cycle of chemotherapy, after each intravenous infusion of paclitaxel, the patient immediately experienced itching symptoms on the distal skin of both upper limbs, which were mild and could be relieved on their own. After the 5th cycle of chemotherapy, the patient′s itching symptoms worsened progressively. Four days later, keratinization of the skin on both hands and forearms of upper limbs appeared, with tight skin and waxy luster, gradually developing towards the proximal end. The modified Rodnan skin score was 1-2 (mild to moderate skin thickening). Laboratory tests showed positive results for anti-nuclear antibodies and anti-centromere antibodies.Pathological examination of skin biopsy tissue of the right forearm showed dermal fibrosis, involving subcutaneous adipose tissue and epidermal atrophy. It was considered to be localized cutaneous systemic sclerosis caused by paclitaxel liposomes. Paclitaxel liposomes was stopped and anti-inflammatory and topical application of glucocorticoids locally treatments were given for 3 days, the patient′s itching symptoms were improved. At a 2-month follow-up, the patient′s itching symptoms were improved and did not recur.

Objective:To analyze the laboratory parameters and clinical characteristics of TTP patients, so as to provide reference for the timely diagnosis and death risk assessment or TTP.Methods:83 patients with TTP from June 2016 to March 2022 in our hospital were analyzed retrospectively. They were divided into survival and death groups. The differences in general information, clinical symptoms and laboratory parameters were compared between the two groups. The prognostic prediction score was constructed by combining parameters which differ between the two groups to calculate the corresponding mortality risk.Results:83 patients were included in the study, of whom 81.1% (60/74), 91.1% (72/79) and 86.2% (50/58) had increased AST, IBIL and cTnI results, and all (78/78) had higher LDH at admission. Hb was decreased in 97.5% (79/81) patients, and PLT of 97.5% (79/81) patients was less than 30×10 9/L. There were no significant differences in gender, age, blood type, presence of fever, ADAMTS-13 activity and PLASMIC score between the survival group (58 cases) and the death group (25 cases), but the proportion of neurologic symptoms in the death group was significantly higher than that in the survival group. AST, IBIL, cTnI and APTT at admission were significantly higher in the death group than in the survival group ( P<0.05). The risk of death was 4.86, 9.74, 3.71, and 5.33 for those with high AST, IBIL, APTT, and cTnI levels, respectively, compared with those with low levels at admission. At last, AST, IBIL, APTT, cTnI and neurological symptoms were included to construct a score model. For each 1 point increase, the risk of short-term death in TTP patients was 3.24. Conclusions:Multiple laboratory markers have high negative exclusion value for TTP. For TTP patients with high AST, IBIL, cTnI and APTT and neurologic symptoms, more attention and active treatment should be paid to reduce mortality.