Immune thrombocytopenia secondary to tuberculosis: a case and review of literature

Weber, S. F.; Bélard, Sabine; Rai, Santosh; Reddy, Revanth; Belurkar, Sushma; Saravu, Kavitha

doi:10.5588/ijtld.16.0515

Cited by 19 publications

(29 citation statements)

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“…While anemia is seen in most miliary TB patients, only up to one quarter have lymphopenia or thrombocytopenia as well [ 24 ]. Thrombocytopenia in TB can result from immune-mediated destruction, hypersplenism and infiltration of the bone marrow [ 25 ]. While ferritin is usually moderately increased in TB, values in excess of 10,000 ng/mL have been described in miliary TB [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Hemophagocytic lymphohistiocytosis and miliary tuberculosis in a previously healthy individual: a case report

et al. 2020

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Background Hemophagocytic lymphohistiocytosis (HLH) is a rare heterogenous genetic or acquired hyperinflammatory syndrome associated with a high degree of morbidity and mortality. HLH has clinical manifestations related to abnormal prolonged activation of T lymphocytes and macrophages with an excess of proinflammatory cytokines. The main causes of secondary HLH are malignancies and infectious diseases. Case presentation The patient was a 54-year-old man, originally from Eastern Africa, who had lived in Northern Europe for 30 years. Here we describe the clinical features, laboratory parameters, diagnostic workup, management and outcome data of a previously healthy 54-year-old man diagnosed with HLH secondary to tuberculosis. The patient was initially treated for a community-acquired pneumonia. He developed multiorgan failure with acute respiratory distress syndrome, hypertransaminasemia, and kidney and bone marrow dysfunction. The clinical course together with a simultaneous increase in serum ferritin raised the suspicion of HLH. The patient fulfilled seven out of eight diagnostic criteria for HLH. A thorough diagnostic workup with respect to HLH and a potential underlying disease was initiated. Cultivation of bronchoalveolar lavage fluid, stool and urine, and polymerase chain reaction of epithelioid cell granulomas in the bone marrow were all positive for Mycobacterium tuberculosis. He was treated for both HLH and tuberculosis, and he survived without any sequelae. Conclusions We present one of few published cases of a patient who survived HLH triggered by miliary tuberculosis. The current case illustrates the need for awareness of these two diagnoses, and the timely initiation of specific and supportive treatment to reduce mortality.

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Section: Discussionmentioning

confidence: 99%

Hemophagocytic lymphohistiocytosis and miliary tuberculosis in a previously healthy individual: a case report

et al. 2020

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“…Isolated thrombocytopenia in patients with TB is rare and hypothesized to be a secondary ITP. One review identified only 50 cases of secondary ITP associated with TB between 1964 and 2016 [7]. Anti-TB drug-induced thrombocytopenia could be caused by isoniazid, rifampicin or both, where autoimmune-mediated rifampicin is the most common [8,9].…”

Section: Discussionmentioning

confidence: 99%

The dilemma in a case of immune thrombocytopenia in a patient with human immunodeficiency virus on antituberculosis treatment for miliary pulmonary tuberculosis

Lugito

Lorens

Kwenandar

et al. 2019

Oxford Medical Case Reports

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The multifactorial mechanisms of immune thrombocytopenia (ITP) in patients with human immunodeficiency virus (HIV) and tuberculosis (TB) could be caused by HIV, TB or anti-TB drugs. No patients with HIV and opportunistic infection of miliary pulmonary TB who developed thrombocytopenia after treatment with anti-TB drugs have been reported. A 47-year-old woman with HIV/acquired immunodeficiency syndrome and miliary TB with normal platelet count (229 000/μL) started anti-TB drugs (rifampicin, isoniazid, pyrazinamide and ethambutol). After 10 days of treatment, her platelet count was low (17 000/μL). As rifampicin and isoniazid were stopped and intravenous methylprednisolone was given, her platelet count began to increase. After more than a month, her platelet count was normal (192 000/μL) and she started antiretrovirals. This improved platelet count after high-dose methylprednisolone is suggestive of ITP; however, the dilemma is whether it was rifampicin alone that caused ITP or did HIV and disseminated TB infection also play a role?

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“…Moreover, 50 cases were summarized by Weber at al. In 2017 Pulmonary TB represented the most common clinical presentation with occurrences of 41% of in all cases which was followed equally at 21% by disseminated TB and the remaining patients had extrapulmonary TB (EPTB) at various sites [32].…”

Section: Discussionmentioning

confidence: 99%

Immune Thrombocytopenia Secondary Splenic Tuberculosis: A Case Report

2018

JCRC

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Despite all the medical and scientific improvements over the past decades; tuberculosis still remains wide-spread and deadly serious. Splenic tuberculosis is a rare form of extra pulmonary tuberculosis. Immune thrombocytopenia is an auto-immune condition that results in isolated thrombocytopenia. Moreover, with its secondary form; it is scientifically proven that immune thrombocytopenia can be triggered with numerous infections or even non-infectious conditions. Although the symptoms and results can be severe, subordinate immune thrombocytopenia which is associated with splenic tuberculosis has not yet taken its crucial and much-needed place in the medical history, surprisingly this matter has not been profoundly covered and analysed yet. A report states that on a 63-year-old patient, diagnostic splenectomy was performed. This elderly patient suffers from purpura and petechial with the cause of immunemediated thrombocytopenia which is secondary to splenic tuberculous; and after the diagnostic splenectomy; splenic tuberculosis was pathologically detected in tests and microbiologic examinations. However, the treatment on patient worked and the medical experts treated the patient with splenectomy and antituberculous therapy. The crucial point here is that patients, who have immune thrombocytopenic purpura, should be exposed to relevant tests and the medical professionals should suspect the high-risk possibility of splenic tuberculosis especially in the endemic area in-patients who have higher risk. Regarding the diagnosis, histopathological examination remains as an ideal method, when it comes to a solid confirmation, executed with microbiological examination.

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Immune thrombocytopenia secondary to tuberculosis: a case and review of literature

Cited by 19 publications

References 0 publications

Hemophagocytic lymphohistiocytosis and miliary tuberculosis in a previously healthy individual: a case report

Hemophagocytic lymphohistiocytosis and miliary tuberculosis in a previously healthy individual: a case report

The dilemma in a case of immune thrombocytopenia in a patient with human immunodeficiency virus on antituberculosis treatment for miliary pulmonary tuberculosis

Immune Thrombocytopenia Secondary Splenic Tuberculosis: A Case Report

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