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Surgery is an Option: Refractory Immune Thrombocytopenia Associated With Tuberculosis

Khurshid, Khawar MD*†; Albanese, Julie A. DO; Carey, Jeanne MD

Infectious Diseases in Clinical Practice: May 2014 - Volume 22 - Issue 3 - p e18–e21
doi: 10.1097/IPC.0b013e31828bbb4d
Case Reports

Background: Mycobacterium tuberculosis may affect any organ. Thrombocytopenia is a rare manifestation of tuberculosis. We report a case of tuberculosis with refractory immune thrombocytopenic purpura requiring splenectomy.

Case Report: A 26-year-old man from China presented with epistaxis, generalized purpuric lesions, difficulty in breathing, productive cough, night sweats for 2 months, and a 15-lb weight loss during the previous 6 months. A petechial rash was noted over the chest, anterior abdominal wall, and extremities. Laboratory results revealed anemia and severe thrombocytopenia. Chest x-ray showed bilateral upper lobe cavitations. Sputum sample confirmed the diagnosis of Mycobacterium tuberculosis. A bone marrow biopsy showed mild hypercellularity of all cell lines with megakaryocytes increased in numbers. Therapy with steroids and immunoglobulin was unsuccessful to treat platelet crisis. After splenectomy, platelet count returned to baseline.

Conclusions: Our case represents a rare clinical phenomenon. In refractory immune thrombocytopenic purpura cases, splenectomy may be essential for the patient survival.

From the *Division of Infectious Disease, Department of Medicine, Maimonides Medical Center; and †Division of Infectious Disease, Department of Medicine, Lutheran Medical Center, Brooklyn, New York.

Correspondence to: Khawar Khurshid, MD, Division of Infectious Disease, Department of Medicine, Maimonides Medical Center, 4719 Fort Hamilton Parkway, Brooklyn, New York 11219. E-mail: kkhurshid@maimonidesmed.org.

The authors have no funding or conflicts of interest to declare.

© 2014 by Lippincott Williams & Wilkins.