A 20-year-old disoriented female is brought to the hospital with a fever of 102°F. Results of the CBC demonstrate a platelet count of 68 × 10⁹/L, a hemoglobin of 9.0 gm/dl, WBC count of 22 × 10⁹/L, and the presence of polychromasia and schistocytes on the peripheral blood smear. Her husband indicated she had no recent episodes of diarrhea but had been taking penicillin for an ongoing infection. The most likely diagnosis for the patient is:

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The clinical presentation of a fever, thrombocytopenia, microangiopathic hemolytic anemia (MAHA) with schistocytes on peripheral blood smear, and neurological symptoms is consistent with thrombotic thrombocytopenic purpura (TTP). The use of penicillin can be a precipitating factor for TTP in some patients. DIC may also present with thrombocytopenia and schistocytes on the peripheral blood smear, but it is usually associated with an underlying condition such as sepsis or malignancy. D-HUS is similar to TTP but is associated with renal failure and is typically caused by an infectious agent, such as E. coli O157:H7. HELLP syndrome classically involves hemolysis, elevated liver enzymes, and low platelet count, but is typically associated with pregnancy-induced hypertension.

A 20-Year-Old Disoriented Female Is Brought to the Hospital with a Fever