TTP presenting as refractory hypoglycemia in a patient with thromboangiitis obliterans

Thrombotic thrombocytopenic purpura (TTP) is a challenging diagnosis to make in the emergency department. We present a case of TTP initially presenting with refractory hypoglycemia in a woman with thromboangiitis obliterans (Buerger's disease). To our knowledge, this is the first description of the association of hypoglycemia and thromboangiitis obliterans with TTP. We briefly review key aspects of the acute diagnosis and management of hypoglycemia and TTP pertinent to the emergency physician.