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Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e31828bbb4d
Case Reports

Surgery is an Option: Refractory Immune Thrombocytopenia Associated With Tuberculosis

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

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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.

© 2014 by Lippincott Williams & Wilkins.

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