Thrombotic thrombocytopenic purpura following zoledronic acid infusion with a fatal outcome.

A 56-year-old woman presented with generalised bone pain with bone mineral density showing severe osteoporosis for which she received a single 4 mg infusion of zoledronic acid (ZA). On the second day following the infusion, she developed fever with altered sensorium. A complete blood count showed anaemia and thrombocytopenia with peripheral blood smear repeatedly showing schistocytes, anisopoikilocytes and target cells.