Abstract
We commented on a recent case report of fulminant myocarditis in immune-mediated thrombotic thrombocytopenic purpura (iTTP). While the authors attributed cardiac dysfunction to myocarditis, we caution that microvascular ischemia remains a plausible mechanism, given the clinical context and nonspecific imaging. Diagnostic clarity is essential because therapeutic strategies may differ from one another. We advocated for a rigorous cardiac evaluation in patients with iTTP to inform appropriate management.