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case_images: 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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case_images: The blood smear revealed several fragmented red cells and scarcity of platelets (Fig. 1).
case_images: 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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case_images: Clinical features and laboratory findings at first admission.
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case_images: 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).
case_images: 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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case_images: A renal biopsy revealed diffuse proliferative glomerulonephritis (Fig. 4).
case_images: Clinical features and laboratory findings at second admission.
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case_images: After 3 sessions in 4 days, the patient improved with no fever and no neurologic abnormality (Fig. 5).