{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T20:08:21Z","timestamp":1789416501964,"version":"build-2803163510"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening hematologic disorder characterized by widespread microvascular thrombosis. Classic clinical features include: fever, microangiopathic hemolytic anemia, thrombocytopenia, renal dysfunction, and neurologic abnormalities, such as altered mental status, confusion, or coma. Prompt recognition and initiation of plasma exchange therapy in the emergency department (ED) are essential for patient survival. We report a case of a 40-year-old female who presented to the ED with a vague complaint of joint pain and no remarkable findings on physical examination. Despite the absence of hallmark features, further evaluation revealed a diagnosis of TTP. This case underscores the diagnostic challenge posed by atypical TTP presentations and highlights the importance of maintaining a high index of suspicion, even in the absence of classic clinical signs.<\/jats:p>","DOI":"10.1093\/omcr\/omag168","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:22:45Z","timestamp":1788520965000},"source":"Crossref","is-referenced-by-count":0,"title":["Recognizing thrombotic thrombocytopenic purpura beyond the pentad"],"prefix":"10.1093","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0181-8499","authenticated-orcid":false,"given":"Olivia M","family":"Pupiec","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Corewell Health Farmington Hills , 28050 Grand River Avenue, Farmington Hills, MI 48336 ,","place":["United States"]},{"name":"Michigan State University College of Osteopathic Medicine , 965 Wilson Road, East Lansing, MI 48824 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie R","family":"Levin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Corewell Health Farmington Hills , 28050 Grand River Avenue, Farmington Hills, MI 48336 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8339-0456","authenticated-orcid":false,"given":"Christopher N","family":"Cooley","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Corewell Health Farmington Hills , 28050 Grand River Avenue, Farmington Hills, MI 48336 ,","place":["United States"]},{"name":"Michigan State University College of Osteopathic Medicine , 965 Wilson Road, East Lansing, MI 48824 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Paratore","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Corewell Health Farmington Hills , 28050 Grand River Avenue, Farmington Hills, MI 48336 ,","place":["United States"]},{"name":"Michigan State University College of Osteopathic Medicine , 965 Wilson Road, East Lansing, MI 48824 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"2026091415535471500_ref1","volume-title":"Platelet Disorders: Thrombotic Thrombocytopenic Purpura (TTP)","author":"National Heart, Lung, and Blood Institute","year":"2025"},{"key":"2026091415535471500_ref2","volume-title":"Thrombotic Thrombocytopenic Purpura","author":"National Organization for Rare Disorders","year":"2025"},{"key":"2026091415535471500_ref3","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1016\/j.jemermed.2012.01.027","article-title":"Thrombotic thrombocytopenic purpura: a Hematological emergency","volume":"43","author":"Kessler","year":"2012","journal-title":"J Emerg Med"},{"key":"2026091415535471500_ref4","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1007\/s004310051234","article-title":"New strategies in diagnosis and treatment of thrombotic thrombocytopenic purpura: case report and review","volume":"158","author":"Haberle","year":"1999","journal-title":"Eur J Pediatr"},{"key":"2026091415535471500_ref5","volume-title":"Thrombotic Thrombocytopenic Purpura: Evaluation and Management","author":"Zuno","year":"2023"},{"key":"2026091415535471500_ref6","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1182\/asheducation-2018.1.530","article-title":"Clinical and laboratory diagnosis of TTP: an integrated approach","volume":"2018","author":"Chiasakul","year":"2018","journal-title":"Hematology Am Soc Hematol Educ Program"},{"key":"2026091415535471500_ref7"}],"container-title":["Oxford Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/omcr\/article-pdf\/2026\/9\/omag168\/71078337\/omag168.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/omcr\/article-pdf\/2026\/9\/omag168\/71078337\/omag168.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T19:53:59Z","timestamp":1789415639000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/omcr\/article\/doi\/10.1093\/omcr\/omag168\/8794366"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":7,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/omcr\/omag168","relation":{},"ISSN":["2053-8855"],"issn-type":[{"value":"2053-8855","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,9,1]]},"article-number":"omag168"}}