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The publication on “Dengue and Thrombotic Thrombocytopenic Purpura (TTP) is very interesting.” Gavali et al. reported a case and raised a conclusion that “timely diagnosis and starting appropriate treatment immediately are key factors for successful outcome.” It is no doubt that TTP can be a complication of dengue. TTP in dengue is sporadically reported and it can be easily missed due to lack of complete diagnostic investigation. Deepanjali et al. noted that “jaundice with a disproportionate elevation of serum aspartate aminotransferase level in a patient with dengue should arouse the suspicion of TTP.” Nevertheless, this important observation was not seen in the present case report by Gavali et al.
In the present case, it is no doubt that there was a co-occurrence of dengue and TTP. However, there are other important concerns. First, there are also other arbovirus infections that might induce TTP such as chikungunya that might be a forgotten concurrent infection. Second, there are also other possible common underlying causes of the reported clinical features that are not ruled out. The important examples are Vitamin B12 and Vitamin D deficiencies.
There are no conflicts of interest.