Surgery is an Option

Refractory Immune Thrombocytopenia Associated With Tuberculosis

Abstract

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.